Provider Demographics
NPI:1174615132
Name:ZEIDLER, BRENDON J (DDS)
Entity type:Individual
Prefix:
First Name:BRENDON
Middle Name:J
Last Name:ZEIDLER
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 1:16366 AZTEC RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-7500
Mailing Address - Country:US
Mailing Address - Phone:408-354-0141
Mailing Address - Fax:
Practice Address - Street 1:5150 GRAVES AVE STE 10A
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-5012
Practice Address - Country:US
Practice Address - Phone:408-257-3530
Practice Address - Fax:408-257-0341
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA546621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice