Healthcare Provider Details

I. General information

NPI: 1073519435
Provider Name (Legal Business Name): BRANDON LLOYD ATKINSON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 10/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 S. MAPLE AVE.
LA CONNER WA
98257
US

IV. Provider business mailing address

721 S. MAPLE AVE
LA CONNER WA
98257
US

V. Phone/Fax

Practice location:
  • Phone: 360-466-3188
  • Fax: 360-466-5074
Mailing address:
  • Phone: 360-466-3188
  • Fax: 360-466-5074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8472
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: