Provider Demographics
NPI:1215288311
Name:DELTORO, BRANDON (DDS)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:
Last Name:DELTORO
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 1:2333 LAMAR AVE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-4757
Mailing Address - Country:US
Mailing Address - Phone:903-785-7671
Mailing Address - Fax:
Practice Address - Street 1:2333 LAMAR AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-4757
Practice Address - Country:US
Practice Address - Phone:903-785-7671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28431122300000X
UT8361694-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist