Healthcare Provider Details

I. General information

NPI: 1336205541
Provider Name (Legal Business Name): JEANETTE LYNN BRANDAL DDS, MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 OLIVE WAY 1556
SEATTLE WA
98101-1720
US

IV. Provider business mailing address

509 OLIVE WAY 1556
SEATTLE WA
98101-1720
US

V. Phone/Fax

Practice location:
  • Phone: 206-292-9926
  • Fax: 206-292-0312
Mailing address:
  • Phone: 206-292-9926
  • Fax: 206-292-0312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number5692
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: