Provider Demographics
NPI:1407301740
Name:GERVAIS, BRANDI (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRANDI
Middle Name:
Last Name:GERVAIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4861 LOGISTICS AVE
Mailing Address - Street 2:JOEL DENTAL CLINIC ATTN CREDENTIALS, BLDG M-4861
Mailing Address - City:FT. LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:28310
Mailing Address - Country:US
Mailing Address - Phone:573-528-3528
Mailing Address - Fax:
Practice Address - Street 1:3817 GRUBER RD BLDG H-3817
Practice Address - Street 2:
Practice Address - City:FORT LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:28310-8925
Practice Address - Country:US
Practice Address - Phone:912-643-2571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32254122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist