Provider Demographics
NPI:1740841592
Name:THROCKMORTON, BRANDON ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:ALAN
Last Name:THROCKMORTON
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 1:340 SE DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-9346
Mailing Address - Country:US
Mailing Address - Phone:515-964-5482
Mailing Address - Fax:515-964-1956
Practice Address - Street 1:340 SE DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-9346
Practice Address - Country:US
Practice Address - Phone:515-964-5482
Practice Address - Fax:515-964-1956
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA09671122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist