Provider Demographics
NPI:1861845885
Name:BEAN, BRANDON C (DDS)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:C
Last Name:BEAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:BRANDON
Other - Middle Name:CHARLES
Other - Last Name:BEAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2301 HOLIDAY DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-3449
Mailing Address - Country:US
Mailing Address - Phone:504-884-9591
Mailing Address - Fax:
Practice Address - Street 1:1301 EASTRIDGE DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-3026
Practice Address - Country:US
Practice Address - Phone:985-643-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA68001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice