MEDICARE: ASHLEY O BRANDON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	18473	MD

General Provider Information

NPI Number	:	1962253476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY O BRANDON

Provider Business Mailing Address
First Line	:	9 TALCOTT RIDGE RD UNIT A2
Second Line	:
City	:	FARMINGTON
State	:	CT
Zip	:	06032-3512
Country	:	US
Telephone Number	:	678-677-0967
Fax Number	:

Provider Business Practice Location Address
First Line	:	28160 OLD VILLAGE RD
Second Line	:
City	:	MECHANICSVILLE
State	:	MD
Zip	:	20659-4289
Country	:	US
Telephone Number	:	301-349-6195
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2024
Last Update Date	:	06/12/2025

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Directions to “ ASHLEY O BRANDON ” Practice Location

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