Provider Demographics
NPI:1568650893
Name:BRANDON THAI DDS, INC
Entity Type:Organization
Organization Name:BRANDON THAI DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:TUAN
Authorized Official - Last Name:THAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-263-6923
Mailing Address - Street 1:28100 BOUQUET CANYON RD
Mailing Address - Street 2:200
Mailing Address - City:SAUGUS
Mailing Address - State:CA
Mailing Address - Zip Code:91350-2005
Mailing Address - Country:US
Mailing Address - Phone:661-263-6923
Mailing Address - Fax:
Practice Address - Street 1:28100 BOUQUET CANYON RD
Practice Address - Street 2:200
Practice Address - City:SAUGUS
Practice Address - State:CA
Practice Address - Zip Code:91350-2005
Practice Address - Country:US
Practice Address - Phone:661-263-6923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA492271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty