Provider Demographics
NPI:1548388580
Name:BRANDON, EDWARD STEPHEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:STEPHEN
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 1:8871 BRECKSVILLE RD STE A
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-1921
Mailing Address - Country:US
Mailing Address - Phone:440-526-8688
Mailing Address - Fax:440-526-0378
Practice Address - Street 1:8871 BRECKSVILLE RD STE A
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-1921
Practice Address - Country:US
Practice Address - Phone:440-526-8688
Practice Address - Fax:440-526-0378
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14216122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist