Provider Demographics
NPI:1558000463
Name:BACHAR, BRANDON RAY (DMD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:RAY
Last Name:BACHAR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15745 W 165TH TER
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-8044
Mailing Address - Country:US
Mailing Address - Phone:913-940-6938
Mailing Address - Fax:
Practice Address - Street 1:10818 PARALLEL PKWY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66109-3649
Practice Address - Country:US
Practice Address - Phone:913-299-8860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS618171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice