Provider Demographics
NPI:1992874689
Name:BRANNOCK, MARY J (DDS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:BRANNOCK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13430 N SCOTTSDALE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-4059
Mailing Address - Country:US
Mailing Address - Phone:480-922-0600
Mailing Address - Fax:480-922-0981
Practice Address - Street 1:13430 N SCOTTSDALE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4059
Practice Address - Country:US
Practice Address - Phone:480-922-0600
Practice Address - Fax:480-922-0981
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4818122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist