Provider Demographics
NPI:1790919769
Name:KRAUS, BRANDY (RDH)
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:
Last Name:KRAUS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 JOHN ROBERTS ROAD
Mailing Address - Street 2:SUITE 10B
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106
Mailing Address - Country:US
Mailing Address - Phone:207-773-3111
Mailing Address - Fax:207-773-3133
Practice Address - Street 1:75 JOHN ROBERTS ROAD
Practice Address - Street 2:SUITE 10B
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106
Practice Address - Country:US
Practice Address - Phone:207-773-3111
Practice Address - Fax:207-773-3133
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERDH 3008124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist