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General NPI Number Information
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NPI Number | 1083901185
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Entity Type | Individual
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Provider Name | LEIGH ANN BRANDENBURG DMD
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Gender | Female
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Dates
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Enumeration Date | 07/09/2011
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Last Update Date | 06/09/2023
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Provider Practice Location Address
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Address Line | 234 N BROADWAY UNIT 606
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City | MILWAUKEE
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State | WI
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Zip | 53202-5825
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Country | US
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Telephone | 262-424-7148
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Fax |
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Provider Business Mailing Address
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Address Line | 328 E 74TH ST
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City | NEW YORK
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State | NY
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Zip | 10021-3708
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 7232-15
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License Number State | WI
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