Provider Demographics
NPI:1154210573
Name:M. BRANDON LANDRETH DMD PLLC
Entity type:Organization
Organization Name:M. BRANDON LANDRETH DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:LANDRETH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:336-287-4607
Mailing Address - Street 1:215 NEW LONDONDALE DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-5615
Mailing Address - Country:US
Mailing Address - Phone:336-287-4607
Mailing Address - Fax:
Practice Address - Street 1:2630 TIMBER DR
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-2571
Practice Address - Country:US
Practice Address - Phone:336-287-4607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental