Provider Demographics
NPI:1184897167
Name:BRANDYBERRY & ASSOCIATES, PLLC
Entity type:Organization
Organization Name:BRANDYBERRY & ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:BRANDYBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:336-475-8181
Mailing Address - Street 1:1602 LIBERTY DRIVE
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-5750
Mailing Address - Country:US
Mailing Address - Phone:336-475-8181
Mailing Address - Fax:336-475-9223
Practice Address - Street 1:1602 LIBERTY DRIVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-5750
Practice Address - Country:US
Practice Address - Phone:336-475-8181
Practice Address - Fax:336-475-9223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27881223G0001X
NC7959122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty