Provider Demographics
NPI:1992977136
Name:ANITA L. BRABSON, D.D.S., INC.
Entity type:Organization
Organization Name:ANITA L. BRABSON, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:BRABSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-397-8877
Mailing Address - Street 1:3620 COUNTY ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3104
Mailing Address - Country:US
Mailing Address - Phone:757-397-8877
Mailing Address - Fax:757-397-8997
Practice Address - Street 1:3620 COUNTY ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3104
Practice Address - Country:US
Practice Address - Phone:757-397-8877
Practice Address - Fax:757-397-8997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007945122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty