Provider Demographics
NPI:1992302731
Name:CARULLO, BRANDY L
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:L
Last Name:CARULLO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9199 REISTERSTOWN RD STE 206B
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4593
Mailing Address - Country:US
Mailing Address - Phone:410-363-2525
Mailing Address - Fax:
Practice Address - Street 1:9199 REISTERSTOWN RD STE 206B
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4593
Practice Address - Country:US
Practice Address - Phone:410-363-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17186122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist