Provider Demographics
NPI:1376271619
Name:ADAMS, BRANDON SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:SCOTT
Last Name:ADAMS
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 1:232 W RANCHO RD
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-4843
Mailing Address - Country:US
Mailing Address - Phone:951-403-1449
Mailing Address - Fax:
Practice Address - Street 1:907 FRONTIER CIR E
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-2423
Practice Address - Country:US
Practice Address - Phone:425-697-9219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-14
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA613011881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADE.61301188OtherWASHINGTON STATE LICENSE