Provider Demographics
NPI:1720868391
Name:HEALD, BRANDI (RDHAP)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:HEALD
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17190 QUAIL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:96022-9055
Mailing Address - Country:US
Mailing Address - Phone:530-356-6780
Mailing Address - Fax:
Practice Address - Street 1:2525 VICTOR AVE STE C
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1465
Practice Address - Country:US
Practice Address - Phone:530-356-6780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP1008124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist