Brandon Greenwalt DMD PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN19737 Issued in FL

Legal business name

BRANDON GREENWALT DMD PLLC

Practice address

12443 San Jose Blvd Ste 101
Jacksonville, FL 32223-8647

Phone

(904) 262-6188

NPI assigned

Jun 6, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Brandon Lee Greenwalt, DMD

Title

President

Phone

(317) 408-5764

Specialties & licenses 1

Addresses

Other names 1

• Greenwalt Family Dentistree Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1465171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465171200000",
    "number": "1154770733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "328 W KARI CT",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322593320",
            "telephone_number": "317-408-5764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12443 SAN JOSE BLVD STE 101",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322238647",
            "telephone_number": "904-262-6188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRANDON GREENWALT DMD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-06",
        "last_updated": "2016-06-06",
        "status": "A",
        "authorized_official_last_name": "GREENWALT",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "317-408-5764",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN19737",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Greenwalt Family Dentistree",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Helen Brandenborg, O.D.
• Shannon M Brandes, CRNA
• Brandi V. Williamson
• Brandis Wig Salon
• Ashlyn Brandler
• Alyssa Janae Brandon
• Michele Alexis Brandon, DO
• Nathan Brandon
• Madison Pumphrey Brandt, M.D.
• Ryan Scott Brandt, MD

• General Practice Dentistry in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.