Provider Demographics
NPI:1467465013
Name:BRANDFASS, DAVID EDWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EDWARD
Last Name:BRANDFASS
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 1:2261 NE 36TH ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-7588
Mailing Address - Country:US
Mailing Address - Phone:954-785-8786
Mailing Address - Fax:
Practice Address - Street 1:2261 NE 36TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-7588
Practice Address - Country:US
Practice Address - Phone:954-785-8786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL56391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice