NPI 1063764025 · live from the CMS NPI Registry
Brian Timothy Bracken, DMD
Dentist, Orthodontics and Dentofacial Orthopedics in Sumter, SC. National Provider Identifier 1063764025, active.
NPI record
| NPI | 1063764025 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dentist, Orthodontics and Dentofacial Orthopedics 1223X0400X |
| Practice location | 1121 Broad St, Sumter, SC 29150 |
| Practice phone | 201-919-1950 |
| Mailing address | 31 Frogmore Rd, Mt Pleasant, SC 29464 |
| Enumerated | October 15, 2012 |
| Last updated | February 2, 2024 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist, Orthodontics and Dentofacial Orthopedics | 1223X0400X | DGD8524 (SC) |
| Dentist, Orthodontics and Dentofacial Orthopedics primary | 1223X0400X | 0401418752 (VA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.