Provider Demographics
NPI:1649657420
Name:BRAND, LUCAS MAX (DDS)
Entity type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:MAX
Last Name:BRAND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 PASATIEMPO GLN
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-7357
Mailing Address - Country:US
Mailing Address - Phone:760-703-3662
Mailing Address - Fax:
Practice Address - Street 1:11199 SORRENTO VALLEY RD STE 204
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1334
Practice Address - Country:US
Practice Address - Phone:858-626-8155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-30
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64780122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No122300000XDental ProvidersDentist