Basic Information
| Provider Information | |||||||||
| NPI: | 1740889773 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ESTES | ||||||||
| FirstName: | BRANDON | ||||||||
| MiddleName: | DEAN | ||||||||
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| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1055 STEWART AVE | ||||||||
| Address2: | BLDG 2018 | ||||||||
| City: | APO | ||||||||
| State: | AA | ||||||||
| PostalCode: | 80914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195561333 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1055 STEWART AVE | ||||||||
| Address2: | BLDG 2018 | ||||||||
| City: | APO | ||||||||
| State: | AA | ||||||||
| PostalCode: | 80914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195561333 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2020 | ||||||||
| LastUpdateDate: | 10/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | TX | Y | Dental Providers | Dental Hygienist |
No ID Information.