Healthcare Provider Details

I. General information

NPI: 1184897167
Provider Name (Legal Business Name): BRANDYBERRY & ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 LIBERTY DRIVE
THOMASVILLE NC
27360-5750
US

IV. Provider business mailing address

1602 LIBERTY DRIVE
THOMASVILLE NC
27360-5750
US

V. Phone/Fax

Practice location:
  • Phone: 336-475-8181
  • Fax: 336-475-9223
Mailing address:
  • Phone: 336-475-8181
  • Fax: 336-475-9223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7959
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2788
License Number StateNC

VIII. Authorized Official

Name: DR. CHRISTIAN ANDREW BRANDYBERRY
Title or Position: DENTIST/OWNER
Credential: D.M.D.
Phone: 336-475-8181