Provider Demographics
NPI:1518140078
Name:BRANDON, CRAIG (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:
Last Name:BRANDON
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 1:17500 SE 392ND ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-9705
Mailing Address - Country:US
Mailing Address - Phone:253-939-2131
Mailing Address - Fax:
Practice Address - Street 1:17500 SE 392ND ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98092-9705
Practice Address - Country:US
Practice Address - Phone:253-939-2131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA508601223G0001X
WADE00007254122300000X
ORD9396122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice