Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 6265 | LA |
N | 204E00000X | Oral & Maxillofacial Surgeon | DE60732399 | WA |
NPI | 1154687770 |
---|---|
Provider Name | Joshua Stephen Brandner |
First Address | Oklahoma City, OK 73124-8977 |
Second Address | Covington, LA 70433-7515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2012 |
Last Update Date | 11/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2304810 | (05) | LA |