Provider Demographics
NPI:1194287011
Name:BRAR, BRANDEN (DDS)
Entity type:Individual
Prefix:
First Name:BRANDEN
Middle Name:
Last Name:BRAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:959 BRUSH HOLLOW RD STE 102
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-1711
Mailing Address - Country:US
Mailing Address - Phone:516-333-5900
Mailing Address - Fax:
Practice Address - Street 1:100 E NEWTON ST # G-407
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2308
Practice Address - Country:US
Practice Address - Phone:617-414-7558
Practice Address - Fax:617-414-7561
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0632931223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty