Brandon Family Dental Care LLC

NPI #1679116412 in Brandon, Florida

Provider Information

NPI Number: 1679116412
Entity Type: Organization
Organization Name: Brandon Family Dental Care LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: Oct 24, 2019
Last Updated: Dec 18, 2019

Practice Location

Address: 227 N KNIGHTS AVE
City: Brandon
State: Florida
ZIP Code: 33510-4390
Phone: (813) 685-5610

Authorized Official

Name: DONNA L LICAUSE
Title: OFFICE MANAGER
Phone: (813) 685-5611

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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