Provider Demographics
NPI:1346586948
Name:BRANDON AU DDS INC
Entity Type:Organization
Organization Name:BRANDON AU DDS INC
Other - Org Name:NEW VISION DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELICA
Authorized Official - Middle Name:
Authorized Official - Last Name:AU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-963-7000
Mailing Address - Street 1:1814 E ROUTE 66 STE B
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-7001
Mailing Address - Country:US
Mailing Address - Phone:626-963-7000
Mailing Address - Fax:626-963-7001
Practice Address - Street 1:1814 E ROUTE 66 STE B
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-7001
Practice Address - Country:US
Practice Address - Phone:626-963-7000
Practice Address - Fax:626-963-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46237122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty