Brandon Colt Clyburn, D.D.S.

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

24644 Issued in TX

Practice address

1505 Emerald PLZ
College Station, TX 77845-1501

Phone

(979) 764-7101

NPI assigned

Jun 16, 2009

Last updated

Apr 30, 2019By the provider in NPPES

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

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Maxillofacial SurgeryAlso: Dentist, Oral Surgery

Education

The Dental School at University of Texas HSC at San Antonio, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Brazos Valley Oms PLLCGroup PAC ID 3173943651, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Brazos Valley Oms PLLC

  dba Brazos Valley Oral & Maxillofacial Surgery

  • Dentist
  • College Station, TX
  • NPI 1194931303
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1245110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556582400000",
    "number": "1619104759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1505 EMERALD PLZ",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778451501",
            "telephone_number": "979-764-7101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 EMERALD PLZ",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778451501",
            "telephone_number": "979-764-7101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLYBURN",
        "first_name": "BRANDON",
        "middle_name": "COLT",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-16",
        "last_updated": "2019-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "TX",
            "license": "24644",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Barbara Del Clark, PHD
• Daniel Lee Clark
• Lauren August Clark, M.D.
• Margaret Ann Clark, PT
• Aron Kay Clyburn, D.D.S.
• Emma Cobb, RD, LD
• Autumn Coffey
• Jason Matthew Cohen, D.O.
• Joshua Cohen, ATC
• Cole Dental PLLC

• Oral & Maxillofacial Surgery (D.M.D.) in College Station, TX
• Providers in College Station, TX by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2019; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.