Provider Demographics
NPI:1871737098
Name:BRANDON DENTAL CARE
Entity type:Organization
Organization Name:BRANDON DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:F
Authorized Official - Last Name:WAITE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-685-0809
Mailing Address - Street 1:413 W ROBERTSON ST STE C
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5014
Mailing Address - Country:US
Mailing Address - Phone:813-685-0809
Mailing Address - Fax:813-685-3290
Practice Address - Street 1:413 W ROBERTSON ST
Practice Address - Street 2:STE. # C
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5014
Practice Address - Country:US
Practice Address - Phone:813-685-0809
Practice Address - Fax:813-685-3290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty