Healthcare Provider Details

I. General information

NPI: 1518140078
Provider Name (Legal Business Name): CRAIG BRANDON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17500 SE 392ND ST
AUBURN WA
98092-9705
US

IV. Provider business mailing address

17500 SE 392ND ST
AUBURN WA
98092-9705
US

V. Phone/Fax

Practice location:
  • Phone: 253-939-2131
  • Fax:
Mailing address:
  • Phone: 253-939-2131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE00007254
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD9396
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number50860
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: