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General NPI Number Information
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NPI Number | 1366997207
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Entity Type | Individual
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Provider Name | BRANDI THOMAS RDH
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Gender | Female
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Dates
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Enumeration Date | 08/21/2016
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Last Update Date | 08/21/2016
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Provider Practice Location Address
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Address Line | 33060 NORTHWESTERN HWY SUITE 200
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-3693
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Country | US
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Telephone | 810-580-8434
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Fax |
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Provider Business Mailing Address
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Address Line | 6531 MARSH RD
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City | COTTRELLVILLE
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State | MI
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Zip | 48039-2105
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 2902018003
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License Number State | MI
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