Provider Demographics
NPI:1700400652
Name:VEACH, BRANDON CRAIG (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:CRAIG
Last Name:VEACH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:BRANDON
Other - Middle Name:CRAIG
Other - Last Name:VEACH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1831 GLYNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-5584
Mailing Address - Country:US
Mailing Address - Phone:334-356-9001
Mailing Address - Fax:334-401-2131
Practice Address - Street 1:1831 GLYNWOOD DR
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-5584
Practice Address - Country:US
Practice Address - Phone:334-356-9001
Practice Address - Fax:334-401-2131
Is Sole Proprietor?:No
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD.0006757-C11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALD.0006757-C1OtherLICENSE NUMBER