Provider Demographics
NPI:1770971079
Name:CERA, BRANDON THOMAS
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:THOMAS
Last Name:CERA
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 1:806 CALLE MEJIA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501
Mailing Address - Country:US
Mailing Address - Phone:505-820-3551
Mailing Address - Fax:505-820-0893
Practice Address - Street 1:806 CALLE MEJIA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501
Practice Address - Country:US
Practice Address - Phone:505-820-3551
Practice Address - Fax:505-820-0893
Is Sole Proprietor?:No
Enumeration Date:2015-01-08
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1223G0001X1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice