Provider Demographics
NPI:1528703709
Name:CABLE, BRANDON JOSEPH
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:JOSEPH
Last Name:CABLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4282 DIAMOND TER
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3156
Mailing Address - Country:US
Mailing Address - Phone:954-661-1677
Mailing Address - Fax:
Practice Address - Street 1:1602 CORTEZ RD W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-1440
Practice Address - Country:US
Practice Address - Phone:941-708-6504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26990122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist