Brian Michael Brancheau, DDS, MSD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DE60306318 Issued in WA

Practice address

4100 194TH St SW Ste 209
Lynnwood, WA 98036-4613

Phone

(206) 422-5083

NPI assigned

Aug 14, 2013

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1376438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549324800000",
    "number": "1407289457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 194TH ST SW STE 209",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980364613",
            "telephone_number": "206-422-5083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 194TH ST SW STE 209",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980364613",
            "telephone_number": "206-422-5083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANCHEAU",
        "first_name": "BRIAN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DDS, MSD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-08-14",
        "last_updated": "2019-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE 60306318",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "WA",
            "license": "DE60306318",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia June Bracy, LPN
• Cashmere Quinn Bradbury, BA, SUDPT
• Braden Partners LP
• Bradley H Jonnes DDS PLLC
• James Clifford Bradley, DC, MS
• Gabrielle Brassfield, LMP
• Alisha Rene Brennan
• Brent M Robinson DDS PS
• Alexandra Grace Breuhaus, PA-C
• Julie Watson Brick, DPT

• Periodontics in Lynnwood, WA
• Providers in Lynnwood, WA by specialty
• Periodontics in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.