Individual
DR. JOHN BRANDEBURA JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
2407 S WALDRON RD, FORT SMITH, AR 72903-3736
(479) 484-1011
(479) 484-1205
Mailing address
2407 S WALDRON RD, FORT SMITH, AR 72903-3736
(479) 484-1011
(479) 484-1205
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2226
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000812852
UNITED CONCORDIA (INDVL)
—
01
—
000861460
UNITED CONCORDIA (GRP)
—
05
—
100026580A
—
OK
05
—
127321679
—
AR
01
—
1548288244
GROUP NPI
—
01
—
5C081
MEDICARE - GROUP NUMBER
AR
Enumeration date
03/24/2006
Last updated
04/28/2009
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