Provider Demographics
NPI:1518128446
Name:BRANDAU, LARRY JAMES (DDS)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:JAMES
Last Name:BRANDAU
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 1:1619 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-8605
Mailing Address - Country:US
Mailing Address - Phone:330-497-4000
Mailing Address - Fax:330-497-4014
Practice Address - Street 1:1619 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-8605
Practice Address - Country:US
Practice Address - Phone:330-497-4000
Practice Address - Fax:330-497-4014
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH16040122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist