Provider Demographics
NPI:1962619775
Name:BRANDT, MARY ELIZABETH (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:BRANDT
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Gender:F
Credentials:DDS, MSD
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Mailing Address - Street 1:370 MEDICAL DR
Mailing Address - Street 2:STE C
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-2916
Mailing Address - Country:US
Mailing Address - Phone:317-844-4104
Mailing Address - Fax:317-844-6121
Practice Address - Street 1:370 MEDICAL DR
Practice Address - Street 2:STE C
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2916
Practice Address - Country:US
Practice Address - Phone:317-844-4104
Practice Address - Fax:317-844-6121
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
IN12009456A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics