Individual
BRANDON JOSEPH STAFFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
114 WALTER REMLEY DR, CRAWFORDSVILLE, IN 47933-3350
(765) 267-8484
Mailing address
114 WALTER REMLEY DR, CRAWFORDSVILLE, IN 47933-3350
(507) 208-3987
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12013947A
IN
1223G0001X
General Practice Dentistry
7627
OK
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/15/2022
Last updated
02/21/2023
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