Provider Demographics
NPI:1073519435
Name:ATKINSON, BRANDON LLOYD (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:LLOYD
Last Name:ATKINSON
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 1:721 S. MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:LA CONNER
Mailing Address - State:WA
Mailing Address - Zip Code:98257
Mailing Address - Country:US
Mailing Address - Phone:360-466-3188
Mailing Address - Fax:360-466-5074
Practice Address - Street 1:721 S. MAPLE AVE.
Practice Address - Street 2:
Practice Address - City:LA CONNER
Practice Address - State:WA
Practice Address - Zip Code:98257
Practice Address - Country:US
Practice Address - Phone:360-466-3188
Practice Address - Fax:360-466-5074
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA84721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1073519435OtherNPPES/ CMS
WA1073519435OtherNPPES