Provider Demographics
NPI:1558747816
Name:ALTHOF, BRANDAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRANDAN
Middle Name:
Last Name:ALTHOF
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 1:23448 SANDSTONE
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-1883
Mailing Address - Country:US
Mailing Address - Phone:949-292-6391
Mailing Address - Fax:
Practice Address - Street 1:30131 TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2034
Practice Address - Country:US
Practice Address - Phone:949-249-3473
Practice Address - Fax:949-249-3494
Is Sole Proprietor?:No
Enumeration Date:2015-08-09
Last Update Date:2015-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64932122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist