MEDICARE: DR. BRANDON C. PARRISH D.D.S., M.S.D.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	12011384A	IN
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	30.023218	OH

General Provider Information

NPI Number	:	1588932644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRANDON C. PARRISH D.D.S., M.S.D.

Provider Business Mailing Address
First Line	:	223 E TILLMAN RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46816-1079
Country	:	US
Telephone Number	:	260-447-2568
Fax Number	:	260-447-1601

Provider Business Practice Location Address
First Line	:	223 E TILLMAN RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46816-1079
Country	:	US
Telephone Number	:	260-447-2568
Fax Number	:	260-447-1601

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

Provider Enumeration Date	:	12/05/2011
Last Update Date	:	12/05/2011

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