Provider Demographics
NPI:1881675981
Name:LEBOURDAIS, BRANDAN LEE (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:BRANDAN
Middle Name:LEE
Last Name:LEBOURDAIS
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:916 WASHINGTON AVE
Mailing Address - Street 2:STE 325
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-5723
Mailing Address - Country:US
Mailing Address - Phone:989-894-2929
Mailing Address - Fax:989-894-4644
Practice Address - Street 1:916 WASHINGTON AVE
Practice Address - Street 2:STE 325
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-5723
Practice Address - Country:US
Practice Address - Phone:989-894-2929
Practice Address - Fax:989-894-4644
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI29010177241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics