Provider Demographics
NPI:1720495104
Name:CAIN, BRANDON MACK (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:MACK
Last Name:CAIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 OUTLET POINTE BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-5667
Mailing Address - Country:US
Mailing Address - Phone:803-851-1280
Mailing Address - Fax:
Practice Address - Street 1:212 OUTLET POINTE BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5667
Practice Address - Country:US
Practice Address - Phone:803-851-1280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2019-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8399122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist