Provider Demographics
NPI:1811259260
Name:BRANDENBURG, DAVID CHARLES (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:CHARLES
Last Name:BRANDENBURG
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 1:7115 GUILFORD DR
Mailing Address - Street 2:STE 101
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-5199
Mailing Address - Country:US
Mailing Address - Phone:240-379-1550
Mailing Address - Fax:301-662-6879
Practice Address - Street 1:7115 GUILFORD DR
Practice Address - Street 2:STE 101
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-5199
Practice Address - Country:US
Practice Address - Phone:240-379-1550
Practice Address - Fax:301-662-6879
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD102214122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist