Individual
DR. BRANDON TIVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3318 S 9TH ST, SAINT LOUIS, MO 63118-2614
(806) 789-5272
Mailing address
3318 S 9TH ST, SAINT LOUIS, MO 63118-2614
(806) 789-5272
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/01/2016
Last updated
06/01/2016
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