Healthcare Provider Details

I. General information

NPI: 1154687770
Provider Name (Legal Business Name): JOSHUA STEPHEN BRANDNER DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 LAKEVIEW CT
COVINGTON LA
70433-7515
US

IV. Provider business mailing address

PO BOX 248977
OKLAHOMA CITY OK
73124-8977
US

V. Phone/Fax

Practice location:
  • Phone: 985-687-1616
  • Fax:
Mailing address:
  • Phone: 877-667-7669
  • Fax: 888-920-7457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDE60732399
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6265
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: