Provider Demographics
NPI:1417137282
Name:FORD, BRANDON MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:MICHAEL
Last Name:FORD
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 1:10153 YORK RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-3398
Mailing Address - Country:US
Mailing Address - Phone:410-628-5300
Mailing Address - Fax:410-628-0978
Practice Address - Street 1:10153 YORK RD
Practice Address - Street 2:SUITE 107
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-3398
Practice Address - Country:US
Practice Address - Phone:410-628-5300
Practice Address - Fax:410-628-0978
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12851122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist