Provider Demographics
NPI:1528593936
Name:CAPE HAZE DENTAL P.A.
Entity Type:Organization
Organization Name:CAPE HAZE DENTAL P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PTSD
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRANDAU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:941-828-2684
Mailing Address - Street 1:8501 PLACIDA RD
Mailing Address - Street 2:SUITE A1
Mailing Address - City:PLACIDA
Mailing Address - State:FL
Mailing Address - Zip Code:33946-2427
Mailing Address - Country:US
Mailing Address - Phone:941-828-2684
Mailing Address - Fax:941-828-2685
Practice Address - Street 1:8501 PLACIDA RD
Practice Address - Street 2:SUITE A1
Practice Address - City:PLACIDA
Practice Address - State:FL
Practice Address - Zip Code:33946-2427
Practice Address - Country:US
Practice Address - Phone:941-828-2684
Practice Address - Fax:941-828-2685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-23
Last Update Date:2017-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN216271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty