Provider Demographics
NPI:1780866301
Name:BRAND, JOHN WOODHALL (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WOODHALL
Last Name:BRAND
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 830740
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68583-0740
Mailing Address - Country:US
Mailing Address - Phone:402-472-1370
Mailing Address - Fax:402-472-2551
Practice Address - Street 1:40TH AND HOLDREGE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68583-0740
Practice Address - Country:US
Practice Address - Phone:403-472-1370
Practice Address - Fax:402-472-2551
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE108122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE4748OtherBC/BS