Provider Demographics
NPI:1306457791
Name:BRANDON JOHNSON DMD PLLC
Entity type:Organization
Organization Name:BRANDON JOHNSON DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-459-0835
Mailing Address - Street 1:15534 RANCH ROAD 620 N STE 300
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-5277
Mailing Address - Country:US
Mailing Address - Phone:512-580-9200
Mailing Address - Fax:512-580-9201
Practice Address - Street 1:15534 RANCH ROAD 620 N STE 300
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-5277
Practice Address - Country:US
Practice Address - Phone:512-580-9200
Practice Address - Fax:512-580-9201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental