David Willis Brantley, D.M.D.
Individual provider Active NPI General Practice Dentistry · Martinez, GA
NPI 1235544404 · NPPES record last updated Apr 12, 2017
Key facts
- NPI
- 1235544404
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DN014795 (GA)
- Practice address
- 495 Furys Ferry Rd
Martinez, GA 30907-8221 - Phone
- (706) 825-6196
- NPI assigned
- Jun 26, 2014
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170301000441 | SC | Order and Referring Only - Dentist |
5496039992 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN014795 | GA | Yes |
Addresses
Primary practice location
495 Furys Ferry Rd
Martinez, GA 30907-8221
Mailing address
495 Furys Ferry Rd
Martinez, GA 30907-8221
Phone (706) 825-6196
Other names
- Dr. Will Brantley
Other providers in Martinez, GA
- A'Raya Bradley
- Donna Marie Bradley
- Shyla Marshay Brailsford
- Chadwick Brantley
- David H. Brantley
- Jerika D Bratton
- Breath of Life Training LLC
- Bridgepoint Health, LLC
- Kimberly Bridi
- Broad Wellness, LLC
All providers in Martinez, GA · General Practice Dentistry in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 12, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.