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General NPI Number Information
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NPI Number | 1679004188
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Entity Type | Organization
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Legal Business Name | GREGORY J. BRANDAU D.D.S., PLLC
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Dates
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Enumeration Date | 03/26/2017
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Last Update Date | 03/26/2017
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Provider Practice Location Address
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Address Line | 2762 TAMIAMI TRL SUITE B
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-5128
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Country | US
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Telephone | 941-629-4804
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Fax | 941-629-7702
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Provider Business Mailing Address
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Address Line | 2762 TAMIAMI TRL SUITE B
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-5128
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Country | US
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Telephone | 941-629-4804
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Fax | 941-629-7702
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Authorized Official
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Title or Position | DENTIST
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Name | DR. GREGORY JAMES BRANDAU
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Credential | D.D.S.
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Telephone | 330-265-1004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN-21627
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License Number State | FL
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