MEDICARE: BRANDON PATRICK ALLEN 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	D011904	AZ

General Provider Information

NPI Number	:	1548942345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON PATRICK ALLEN DDS

Provider Business Mailing Address
First Line	:	1060 S HARRISON RD STE 110
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85748-6603
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1060 S HARRISON RD STE 110
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85748-6603
Country	:	US
Telephone Number	:	520-917-0666
Fax Number	:

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

Provider Enumeration Date	:	08/02/2023
Last Update Date	:	08/02/2023

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Directions to “ BRANDON PATRICK ALLEN DDS” Practice Location

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