Provider Demographics
NPI:1427213594
Name:PRIEBE, BRANDON MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:MICHAEL
Last Name:PRIEBE
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 1:1392 E 1900 N
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2022
Mailing Address - Country:US
Mailing Address - Phone:206-218-5676
Mailing Address - Fax:
Practice Address - Street 1:105 HIGHWAY 91
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:UT
Practice Address - Zip Code:84333-1278
Practice Address - Country:US
Practice Address - Phone:435-258-2301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7073264-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice