Provider Demographics
NPI:1134702558
Name:BRANDWEIN, JEREMY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:
Last Name:BRANDWEIN
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 1:243 S MAIN ST STE 121
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:NY
Mailing Address - Zip Code:14411-1655
Mailing Address - Country:US
Mailing Address - Phone:585-589-9044
Mailing Address - Fax:
Practice Address - Street 1:243 S MAIN ST STE 121
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NY
Practice Address - Zip Code:14411-1655
Practice Address - Country:US
Practice Address - Phone:585-589-9044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062534122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist