Provider Demographics
NPI:1457618423
Name:PITCHER, BRANDON CHARLES (DDS)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:CHARLES
Last Name:PITCHER
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 1:819 NEEDHAM DR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-9403
Mailing Address - Country:US
Mailing Address - Phone:303-523-0288
Mailing Address - Fax:
Practice Address - Street 1:819 NEEDHAM DR
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-9403
Practice Address - Country:US
Practice Address - Phone:303-523-0288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
UT10217386-99221223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program