Provider Demographics
NPI:1417037037
Name:BRANDT, JOAN VILLA (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:VILLA
Last Name:BRANDT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 LOCUST LN
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-5677
Mailing Address - Country:US
Mailing Address - Phone:717-652-6352
Mailing Address - Fax:717-541-0771
Practice Address - Street 1:5525 LOCUST LN
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5677
Practice Address - Country:US
Practice Address - Phone:717-652-6352
Practice Address - Fax:717-541-0771
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022415L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice