MEDICARE: BRANDON HARRIS

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	1223G0001X	General Practice Dentistry	D010346	AZ

General Provider Information

NPI Number	:	1467010991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON HARRIS

Provider Business Mailing Address
First Line	:	4954 W JEREMY DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-1405
Country	:	US
Telephone Number	:	949-246-3820
Fax Number	:

Provider Business Practice Location Address
First Line	:	10503 W THUNDERBIRD BLVD STE 371
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85351-2721
Country	:	US
Telephone Number	:	400-977-4001
Fax Number	:

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

Provider Enumeration Date	:	05/30/2019
Last Update Date	:	07/11/2019

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