Provider Demographics
NPI:1942327358
Name:BRANDER, EUGENE E (DDS, PC)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:E
Last Name:BRANDER
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E RIVERSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-4547
Mailing Address - Country:US
Mailing Address - Phone:815-633-1815
Mailing Address - Fax:815-633-1627
Practice Address - Street 1:309 E RIVERSIDE BLVD
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-4547
Practice Address - Country:US
Practice Address - Phone:815-633-1815
Practice Address - Fax:815-633-1627
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL171221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice