Provider Demographics
NPI:1750883369
Name:BRANDON MCKAY DEVER, DDS A DENTAL CORPORATION
Entity type:Organization
Organization Name:BRANDON MCKAY DEVER, DDS A DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-823-2423
Mailing Address - Street 1:2350 GRASS VALLEY HWY
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-2554
Mailing Address - Country:US
Mailing Address - Phone:530-823-2423
Mailing Address - Fax:530-823-5580
Practice Address - Street 1:2350 GRASS VALLEY HWY
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2554
Practice Address - Country:US
Practice Address - Phone:530-823-2423
Practice Address - Fax:530-823-5580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty