Provider Demographics
NPI:1134485154
Name:REDDINGER, BRANDON WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:WILLIAM
Last Name:REDDINGER
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 1:512 N YOUNG ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7839
Mailing Address - Country:US
Mailing Address - Phone:509-783-7600
Mailing Address - Fax:
Practice Address - Street 1:512 N YOUNG ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7839
Practice Address - Country:US
Practice Address - Phone:509-783-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6883-15122300000X
WADE605959621223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery