Healthcare Provider Details

I. General information

NPI: 1003992215
Provider Name (Legal Business Name): DR PAUL L BRANDT JR DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14231 N 7TH STREET SUITE A1
PHOENIX AZ
85022
US

IV. Provider business mailing address

14231 N 7TH STREET SUITE A1
PHOENIX AZ
85022
US

V. Phone/Fax

Practice location:
  • Phone: 602-942-1461
  • Fax: 602-942-1763
Mailing address:
  • Phone: 602-942-1461
  • Fax: 602-942-1763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number1604
License Number StateAZ

VIII. Authorized Official

Name: DR. PAUL LOULS BRANDT JR.
Title or Position: OWNER
Credential: DDS
Phone: 602-942-1461