Provider Demographics
NPI:1154382091
Name:BRANDTNER, ALEX J (DDS MS)
Entity type:Individual
Prefix:MR
First Name:ALEX
Middle Name:J
Last Name:BRANDTNER
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Gender:M
Credentials:DDS MS
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Mailing Address - Street 1:5108 JERSEY RIDGE RD
Mailing Address - Street 2:STE B
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807
Mailing Address - Country:US
Mailing Address - Phone:563-355-0437
Mailing Address - Fax:563-355-2742
Practice Address - Street 1:5108 JERSEY RIDGE RD
Practice Address - Street 2:STE B
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807
Practice Address - Country:US
Practice Address - Phone:563-355-0437
Practice Address - Fax:563-355-2742
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
IA067361223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0207837Medicaid