Individual
JOSHUA STEPHEN BRANDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MD
Contact information
Practice address
363 LAKEVIEW CT, COVINGTON, LA 70433-7515
(985) 687-1616
Mailing address
PO BOX 248977, OKLAHOMA CITY, OK 73124-8977
(877) 667-7669
(888) 920-7457
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
6265
LA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
DE60732399
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2304810
—
LA
Enumeration date
04/09/2012
Last updated
11/11/2021
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