NPIMap

Organization Active NPI

Gregory J. Brandau D.D.S., PLLC

  • General Practice Dentistry
  • Port Charlotte, FL
National Provider Identifier
1679004188
Registry record updated Mar 26, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN-21627 Issued in FL
Legal business name
GREGORY J. BRANDAU D.D.S., PLLC
Doing business as
Brandau Family Dentistry
Practice address
2762 Tamiami TRL
Suite B
Port Charlotte, FL 33952-5128
Phone
(941) 629-4804
Fax
(941) 629-7702
NPI assigned
Mar 26, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2017

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

Authorized official

Name
Dr. Gregory James Brandau, D.D.S.NPI 1750784955
Title
Dentist
Phone
(330) 265-1004

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X DN-21627 FL Primary

Addresses

Primary practice location

2762 Tamiami TRL
Suite B
Port Charlotte, FL 33952-5128

Mailing address

2762 Tamiami TRL
Suite B
Port Charlotte, FL 33952-5128
Phone (941) 629-4804

Other names 1

  • Brandau Family Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

2762 Tamiami Trl
#B
Port Charlotte, FL 33952
Phone (941) 629-4804

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1490486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490486400000",
    "number": "1679004188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2762 TAMIAMI TRL",
            "address_2": "SUITE B",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339525128",
            "telephone_number": "941-629-4804",
            "fax_number": "941-629-7702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2762 TAMIAMI TRL",
            "address_2": "SUITE B",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339525128",
            "telephone_number": "941-629-4804",
            "fax_number": "941-629-7702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREGORY J. BRANDAU D.D.S., PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-26",
        "last_updated": "2017-03-26",
        "status": "A",
        "authorized_official_last_name": "BRANDAU",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "330-265-1004",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN-21627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brandau Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Charlotte, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2017; 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.