Provider Demographics
NPI:1528613718
Name:WEST, BRANDON MARSHALL (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:MARSHALL
Last Name:WEST
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9515 DEERECO RD STE 308
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2152
Mailing Address - Country:US
Mailing Address - Phone:410-252-0871
Mailing Address - Fax:
Practice Address - Street 1:9515 DEERECO RD STE 308
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2152
Practice Address - Country:US
Practice Address - Phone:410-252-0871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.032256122300000X
IL021.0029811223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist