Provider Demographics
NPI:1881003226
Name:ECHELBERRY, BRANDY (RDH)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:ECHELBERRY
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 1:17400 MONTEREY ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-7318
Mailing Address - Country:US
Mailing Address - Phone:408-612-8877
Mailing Address - Fax:
Practice Address - Street 1:17400 MONTEREY ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-7318
Practice Address - Country:US
Practice Address - Phone:408-612-8877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDH18943124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist