Provider Demographics
NPI:1740889773
Name:ESTES, BRANDON DEAN
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:DEAN
Last Name:ESTES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 STEWART AVE
Mailing Address - Street 2:BLDG 2018
Mailing Address - City:APO
Mailing Address - State:AA
Mailing Address - Zip Code:80914
Mailing Address - Country:US
Mailing Address - Phone:719-556-1333
Mailing Address - Fax:
Practice Address - Street 1:1055 STEWART AVE
Practice Address - Street 2:BLDG 2018
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:80914
Practice Address - Country:US
Practice Address - Phone:719-556-1333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist