Provider Demographics
NPI:1003992215
Name:DR PAUL L BRANDT JR DDS PC
Entity type:Organization
Organization Name:DR PAUL L BRANDT JR DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:LOULS
Authorized Official - Last Name:BRANDT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-942-1461
Mailing Address - Street 1:14231 N 7TH STREET
Mailing Address - Street 2:SUITE A1
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022
Mailing Address - Country:US
Mailing Address - Phone:602-942-1461
Mailing Address - Fax:602-942-1763
Practice Address - Street 1:14231 N 7TH STREET
Practice Address - Street 2:SUITE A1
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022
Practice Address - Country:US
Practice Address - Phone:602-942-1461
Practice Address - Fax:602-942-1763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1604261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental