Provider Demographics
NPI:1053481663
Name:THAI, BRANDON TUAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:TUAN
Last Name:THAI
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 1:28100 BOUQUET CANYON RD 200
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:CA
Mailing Address - Zip Code:91350-2006
Mailing Address - Country:US
Mailing Address - Phone:661-263-6923
Mailing Address - Fax:661-263-9776
Practice Address - Street 1:28100 BOUQUET CANYON RD 200
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:CA
Practice Address - Zip Code:91350-2006
Practice Address - Country:US
Practice Address - Phone:661-263-6923
Practice Address - Fax:661-263-9776
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA492271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice