John Brandebura Jr., D.M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

2226 Issued in AR

Practice address

2407 S Waldron Rd
Fort Smith, AR 72903-3736

Phone

(479) 484-1011

Fax

(479) 484-1205

NPI assigned

Mar 24, 2006

Last updated

Apr 28, 2009By 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

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

• River Valley Oral & Maxillofacial Surgery PLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Fort Smith, AR
  • NPI 1548288244
  NPD (past)

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

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1240876800000",
    "number": "1629038708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2407 S WALDRON RD",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729033736",
            "telephone_number": "479-484-1011",
            "fax_number": "479-484-1205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2407 S WALDRON RD",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729033736",
            "telephone_number": "479-484-1011",
            "fax_number": "479-484-1205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANDEBURA",
        "first_name": "JOHN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-24",
        "last_updated": "2009-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AR",
            "license": "2226",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127321679",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE - GROUP NUMBER",
            "identifier": "5C081",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100026580A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA (INDVL)",
            "identifier": "000812852",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1548288244",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA (GRP)",
            "identifier": "000861460",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jo Beth Bradshaw Dobbins, CRNA
• Jody Bradshaw, MD
• Sylvia Bradshaw
• Lori Brady
• Blakelynn Brake
• Brandy Cunningham (Brandy Cunningham LCSW LLC)
• Taylor Elizabeth Branton, LPE-PL
• Russell B Branum, MD
• Dulcy L Brasher, MHPP
• Sunny Bray, NP-C

• Oral and Maxillofacial Surgery (Dentist) in Fort Smith, AR
• Providers in Fort Smith, AR by specialty
• Oral and Maxillofacial Surgery (Dentist) in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2009; 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.