Provider Demographics
NPI:1992919427
Name:ROBISON, BRANDON J
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:J
Last Name:ROBISON
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 1:3590 W 9000 S STE 325
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-8832
Mailing Address - Country:US
Mailing Address - Phone:801-748-1399
Mailing Address - Fax:801-748-1426
Practice Address - Street 1:3590 W 9000 S STE 325
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-8832
Practice Address - Country:US
Practice Address - Phone:801-748-1399
Practice Address - Fax:801-748-1426
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5896284-89031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice