Provider Demographics
NPI:1114020260
Name:BRANTLEY, JOSEPH ADAMS (DMD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ADAMS
Last Name:BRANTLEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 CHATHAM AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-2734
Mailing Address - Country:US
Mailing Address - Phone:803-256-1817
Mailing Address - Fax:
Practice Address - Street 1:621 CHATHAM AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-2734
Practice Address - Country:US
Practice Address - Phone:803-256-1817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3605122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist