Randall Stephen Brannon, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4111 Issued in WV

Practice address

350 Hospital Dr
Spencer, WV 25276-1049

Phone

(304) 927-2775

Fax

(304) 927-2777

NPI assigned

Jun 10, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2017 through Jan 1, 2027

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Brannon Dental Associates PLLC

  • General Practice Dentistry
  • Spencer, WV
  • NPI 1275631871
  NPD (past) Authorized official

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

{
    "created_epoch": "1402358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402358400000",
    "number": "1598178295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 HOSPITAL DR",
            "city": "SPENCER",
            "state": "WV",
            "postal_code": "252761049",
            "telephone_number": "304-927-2775",
            "fax_number": "304-927-2777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 HOSPITAL DR",
            "city": "SPENCER",
            "state": "WV",
            "postal_code": "252761049",
            "telephone_number": "304-927-2775",
            "fax_number": "304-927-2777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANNON",
        "first_name": "RANDALL",
        "middle_name": "STEPHEN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-10",
        "last_updated": "2014-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WV",
            "license": "4111",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sierra Bowen
• Ryan Marshall Brabham, PTA
• Rachelle Brandenstein
• Brannon Dental Associates PLLC
• Eric Randall Brannon, DDS
• Regina Janet Brannon, DDS
• Carly Marie Brohard, DPT
• Connie Sue Burdette
• Connie Burrows
• Mary Elizabeth Byrne, COTA

• General Practice Dentistry in Spencer, WV
• Providers in Spencer, WV by specialty
• General Practice Dentistry in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.