Individual
KEITH BRANNEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-8916
(503) 494-6783
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-8916
(503) 494-6783
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D11353
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/15/2016
Last updated
06/13/2022
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