Provider Demographics
NPI:1184720328
Name:BRANDT, WAYNE (DDS)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:
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 1:233 CAJON ST
Mailing Address - Street 2:STE. 2
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5257
Mailing Address - Country:US
Mailing Address - Phone:909-792-1156
Mailing Address - Fax:
Practice Address - Street 1:233 CAJON ST
Practice Address - Street 2:STE. 2
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5257
Practice Address - Country:US
Practice Address - Phone:909-792-1156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28845122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist