Provider Demographics
NPI:1750498978
Name:BRANDOM, DAVID JAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JAY
Last Name:BRANDOM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:32241 CROWN VALLEY PKWY
Mailing Address - Street 2:STE 230
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629
Mailing Address - Country:US
Mailing Address - Phone:949-496-2801
Mailing Address - Fax:949-496-7365
Practice Address - Street 1:32241 CROWN VALLEY PKWY
Practice Address - Street 2:STE 230
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629
Practice Address - Country:US
Practice Address - Phone:949-496-2801
Practice Address - Fax:949-496-7365
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26343122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist