Provider Demographics
NPI:1346743044
Name:NATHANIEL AND KATHERINE BEHRENTS DDS PC
Entity Type:Organization
Organization Name:NATHANIEL AND KATHERINE BEHRENTS DDS PC
Other - Org Name:BEHRENTS ENDODONTIC SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-445-6884
Mailing Address - Street 1:152 E APPLEBY RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-3903
Mailing Address - Country:US
Mailing Address - Phone:479-445-6884
Mailing Address - Fax:
Practice Address - Street 1:5305 W VILLAGE PKWY STE 12
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8116
Practice Address - Country:US
Practice Address - Phone:479-445-6884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-09
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1764261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental