Healthcare Provider Details

I. General information

NPI: 1366056848
Provider Name (Legal Business Name): BRANDON LEE ZIPPER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N CONGRESS AVE STE 108
BOYNTON BEACH FL
33426-3316
US

IV. Provider business mailing address

901 N CONGRESS AVE STE 108
BOYNTON BEACH FL
33426-3316
US

V. Phone/Fax

Practice location:
  • Phone: 561-880-4334
  • Fax:
Mailing address:
  • Phone: 561-880-4334
  • Fax: 561-880-4871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN23812
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: