Provider Demographics
NPI:1780754960
Name:TIEK, BRANDON KENNETH (DDS)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:KENNETH
Last Name:TIEK
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14390 CLAY TERRACE BLVD
Mailing Address - Street 2:SUITE 249
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3627
Mailing Address - Country:US
Mailing Address - Phone:317-815-9800
Mailing Address - Fax:
Practice Address - Street 1:14390 CLAY TERRACE BLVD
Practice Address - Street 2:SUITE 249
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3627
Practice Address - Country:US
Practice Address - Phone:317-815-9800
Practice Address - Fax:317-815-5760
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120105661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice