Provider Demographics
NPI:1396074969
Name:BRANDON M. PIPER, DMD, P.C.
Entity type:Organization
Organization Name:BRANDON M. PIPER, DMD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PIPER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-977-5245
Mailing Address - Street 1:2627 SPYGLASS CT APT D
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-3679
Mailing Address - Country:US
Mailing Address - Phone:618-977-5245
Mailing Address - Fax:
Practice Address - Street 1:469 W WOOD ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62522-3109
Practice Address - Country:US
Practice Address - Phone:217-428-3512
Practice Address - Fax:217-428-3525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190276841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty