Provider Demographics
NPI:1003823501
Name:BRANDON, DALE EDWIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:EDWIN
Last Name:BRANDON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18700 MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1714
Mailing Address - Country:US
Mailing Address - Phone:714-375-7222
Mailing Address - Fax:714-375-9612
Practice Address - Street 1:18700 MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1714
Practice Address - Country:US
Practice Address - Phone:714-375-7222
Practice Address - Fax:714-375-9612
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD193301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice