Individual
BRANDON WAYNE COUSINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
485 WILDWOOD PKWY STE 5, BALLWIN, MO 63011-2667
(636) 227-8400
Mailing address
485 WILDWOOD PKWY STE 5, BALLWIN, MO 63011-2667
(636) 227-8400
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2018016943
MO
Other
Enumeration date
05/29/2018
Last updated
02/23/2024
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