Individual
MR. JAMES WALLACE BRANTLEY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
5685 HWY 18 WEST, JACKSON, MS 39209-9622
(603) 373-2404
(601) 373-4443
Mailing address
5685 HWY 18 WEST, JACKSON, MS 39209-9622
(603) 373-2404
(601) 373-4443
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
179478
MS
Other
Enumeration date
05/22/2007
Last updated
07/08/2007
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