Provider Demographics
NPI:1104958727
Name:HARBIN, BRANDON SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:SCOTT
Last Name:HARBIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 NEW SHACKLE ISLAND RD
Mailing Address - Street 2:STE 170
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2485
Mailing Address - Country:US
Mailing Address - Phone:615-822-8262
Mailing Address - Fax:615-822-8682
Practice Address - Street 1:230 NEW SHACKLE ISLAND RD
Practice Address - Street 2:STE 170
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2485
Practice Address - Country:US
Practice Address - Phone:615-822-8262
Practice Address - Fax:615-822-8682
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027185122300000X
TN86481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist