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General NPI Number Information
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NPI Number | 1003992215
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Entity Type | Organization
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Legal Business Name | DR PAUL L BRANDT JR DDS PC
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 14231 N 7TH STREET SUITE A1
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City | PHOENIX
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State | AZ
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Zip | 85022
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Country | US
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Telephone | 602-942-1461
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Fax | 602-942-1763
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Provider Business Mailing Address
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Address Line | 14231 N 7TH STREET SUITE A1
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City | PHOENIX
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State | AZ
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Zip | 85022
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Country | US
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Telephone | 602-942-1461
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Fax | 602-942-1763
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAUL LOULS BRANDT JR.
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Credential | DDS
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Telephone | 602-942-1461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 1604
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License Number State | AZ
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