Provider Demographics
NPI:1063861623
Name:LADEAU, BRANDON A (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:A
Last Name:LADEAU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 OAKLAND ST APT 1
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1801
Mailing Address - Country:US
Mailing Address - Phone:978-257-7050
Mailing Address - Fax:
Practice Address - Street 1:11 FLORENCE ST
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-2822
Practice Address - Country:US
Practice Address - Phone:508-485-0401
Practice Address - Fax:508-786-5900
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-05
Last Update Date:2016-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856919122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist