Provider Demographics
NPI:1962060798
Name:BRANDON, TOBY WAYNE (DMD)
Entity type:Individual
Prefix:DR
First Name:TOBY
Middle Name:WAYNE
Last Name:BRANDON
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 1:1065 COUNTY ROAD 1948
Mailing Address - Street 2:
Mailing Address - City:SALTILLO
Mailing Address - State:MS
Mailing Address - Zip Code:38866-6835
Mailing Address - Country:US
Mailing Address - Phone:662-279-4535
Mailing Address - Fax:
Practice Address - Street 1:2864 TRACELAND DR
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4200
Practice Address - Country:US
Practice Address - Phone:662-842-0212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4047-191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice