Provider Demographics
NPI:1336237445
Name:BRANTON, SHAWN RYAN (DMD)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:RYAN
Last Name:BRANTON
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 1:301 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-5129
Mailing Address - Country:US
Mailing Address - Phone:570-322-8501
Mailing Address - Fax:570-329-3576
Practice Address - Street 1:301 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-5129
Practice Address - Country:US
Practice Address - Phone:570-322-8501
Practice Address - Fax:570-329-3576
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029016L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU58570Medicare UPIN