Provider Demographics
NPI:1487201406
Name:BRANDT DENTAL LLC
Entity Type:Organization
Organization Name:BRANDT DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:BRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-460-6303
Mailing Address - Street 1:5075 E UNIVERSITY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:IA
Mailing Address - Zip Code:50327-7001
Mailing Address - Country:US
Mailing Address - Phone:515-265-6484
Mailing Address - Fax:
Practice Address - Street 1:5075 E UNIVERSITY AVE STE A
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:IA
Practice Address - Zip Code:50327-7001
Practice Address - Country:US
Practice Address - Phone:515-265-6484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty