Provider Demographics
NPI:1558655886
Name:LADOUX, BRANDON (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:
Last Name:LADOUX
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 1:100 N TRIBAL CENTER RD
Mailing Address - Street 2:
Mailing Address - City:SKOKOMISH NATION
Mailing Address - State:WA
Mailing Address - Zip Code:98584-9748
Mailing Address - Country:US
Mailing Address - Phone:360-426-5755
Mailing Address - Fax:
Practice Address - Street 1:100 N TRIBAL CENTER RD
Practice Address - Street 2:
Practice Address - City:SKOKOMISH NATION
Practice Address - State:WA
Practice Address - Zip Code:98584-9748
Practice Address - Country:US
Practice Address - Phone:360-426-5755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 602141111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice