Individual
GREG BRANDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
907 N. ANKENY BLVD., ANKENY, IA 50023-1711
(515) 964-1490
(515) 965-5603
Mailing address
PO BOX 547, ANKENY, IA 50021-0547
(515) 964-1490
(515) 965-5603
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6962
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0216499
—
IA
01
—
514194
TRICARE
IA
Enumeration date
07/17/2006
Last updated
07/08/2007
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