Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 34673 | CA |
NPI | 1114165255 |
---|---|
Provider Name | Dr. Robert H Brandes |
First Address | Livermore, CA 94550-4143 |
Second Address | Livermore, CA 94550-4143 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2009 |
Last Update Date | 28/01/2009 |