Individual
DR. SIDNEY WAYNE BRANTLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
166 N FRIENDSHIP RD, PADUCAH, KY 42001-5602
(270) 554-0123
(270) 554-0336
Mailing address
166 N FRIENDSHIP RD, PADUCAH, KY 42001-5602
(270) 554-0123
(270) 554-0336
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
5162
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5162
STATE LICENSE #
KY
Enumeration date
04/09/2007
Last updated
07/08/2007
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