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General NPI Number Information
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NPI Number | 1346586948
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Entity Type | Organization
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Legal Business Name | BRANDON AU DDS INC
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Dates
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Enumeration Date | 12/31/2012
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Last Update Date | 12/31/2012
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Provider Practice Location Address
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Address Line | 1814 E ROUTE 66 STE B
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City | GLENDORA
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State | CA
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Zip | 91740-7001
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Country | US
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Telephone | 626-963-7000
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Fax | 626-963-7001
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Provider Business Mailing Address
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Address Line | 1814 E ROUTE 66 STE B
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City | GLENDORA
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State | CA
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Zip | 91740-7001
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Country | US
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Telephone | 626-963-7000
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Fax | 626-963-7001
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | ANGELICA AU
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Credential |
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Telephone | 626-963-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 46237
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License Number State | CA
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