Provider Demographics
NPI:1336879535
Name:CANADAY, BRANDON R (DMD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:R
Last Name:CANADAY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6405 JACK WRIGHT ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-1910
Mailing Address - Country:US
Mailing Address - Phone:904-521-3899
Mailing Address - Fax:
Practice Address - Street 1:4873 BELLE TERRE PKWY
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8696
Practice Address - Country:US
Practice Address - Phone:386-864-8313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN27075122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program