Provider Demographics
NPI:1790852382
Name:PRICE, BRANDON D (DMD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:D
Last Name:PRICE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14628 N 142ND LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-8728
Mailing Address - Country:US
Mailing Address - Phone:623-975-9543
Mailing Address - Fax:
Practice Address - Street 1:5520 INDEPENDENCE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-4607
Practice Address - Country:US
Practice Address - Phone:121-438-3095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX251361223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics