Provider Demographics
NPI:1053594416
Name:SCHVANEVELDT, BRANDON (DDS)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:
Last Name:SCHVANEVELDT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:BRANDON
Other - Middle Name:
Other - Last Name:SCHVANEVELDT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:398 SOUTH MAIN
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-3445
Mailing Address - Country:US
Mailing Address - Phone:435-752-1434
Mailing Address - Fax:435-752-1986
Practice Address - Street 1:398 SOUTH MAIN
Practice Address - Street 2:SUITE 120
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321
Practice Address - Country:US
Practice Address - Phone:435-752-1434
Practice Address - Fax:435-752-1986
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5412590-89031223G0001X
IDD-36991223G0001X
UT5412590-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice