MEDICARE: BRANDON KAZZAZI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D12027	OR

General Provider Information

NPI Number	:	1053158840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON KAZZAZI DDS

Provider Business Mailing Address
First Line	:	1100 NE E ST
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-2369
Country	:	US
Telephone Number	:	541-479-5505
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 NE E ST
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-2369
Country	:	US
Telephone Number	:	641-479-5505
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2024
Last Update Date	:	07/16/2024

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Directions to “ BRANDON KAZZAZI DDS” Practice Location

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