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General NPI Number Information
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NPI Number | 1780754960
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Entity Type | Individual
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Provider Name | BRANDON KENNETH TIEK DDS
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Gender | Male
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 2362 W BOULEVARD STE B
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City | KOKOMO
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State | IN
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Zip | 46902-6081
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Country | US
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Telephone | 765-236-1570
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Fax | 765-236-1571
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Provider Business Mailing Address
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Address Line | 2362 W BOULEVARD STE B
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City | KOKOMO
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State | IN
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Zip | 46902-6081
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Country | US
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Telephone | 765-236-1570
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Fax | 765-236-1571
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12010566
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License Number State | IN
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