Provider Demographics
NPI:1639713746
Name:DELGADO, BRANDO BRYAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRANDO
Middle Name:BRYAN
Last Name:DELGADO
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 1:3216 NW 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-7366
Mailing Address - Country:US
Mailing Address - Phone:503-679-1866
Mailing Address - Fax:
Practice Address - Street 1:2206 KAEN RD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4090
Practice Address - Country:US
Practice Address - Phone:503-722-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD11176122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist