Provider Demographics
NPI:1942204813
Name:BRANDT, JASON DENNIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:DENNIS
Last Name:BRANDT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13663 OFFICE PL
Mailing Address - Street 2:STE 103
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4216
Mailing Address - Country:US
Mailing Address - Phone:703-878-2100
Mailing Address - Fax:703-878-2422
Practice Address - Street 1:13663 OFFICE PL
Practice Address - Street 2:STE 103
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4216
Practice Address - Country:US
Practice Address - Phone:703-878-2100
Practice Address - Fax:703-878-2422
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401008838122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist