Provider Demographics
NPI:1659531275
Name:MARTIN, BRANDON DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:DAVID
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10619 WEYMOUTH ST APT 102
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4234
Mailing Address - Country:US
Mailing Address - Phone:202-725-5512
Mailing Address - Fax:
Practice Address - Street 1:3645 NORTHGATE BLVD STE A
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1641
Practice Address - Country:US
Practice Address - Phone:916-286-7750
Practice Address - Fax:916-286-7757
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA569211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics