Provider Demographics
NPI:1730262866
Name:BLADES, BRANDON ROBERT (DMD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:ROBERT
Last Name:BLADES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 TEANECK RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4241
Mailing Address - Country:US
Mailing Address - Phone:201-837-1666
Mailing Address - Fax:201-837-1019
Practice Address - Street 1:757 TEANECK RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4241
Practice Address - Country:US
Practice Address - Phone:201-837-1666
Practice Address - Fax:201-837-1019
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice