Provider Demographics
NPI:1396184396
Name:BEHRENS, BRANDY NICOLE (DDS)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:NICOLE
Last Name:BEHRENS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:NICOLE
Other - Last Name:PAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:13211 MEANDER COVE DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-3731
Mailing Address - Country:US
Mailing Address - Phone:315-250-2162
Mailing Address - Fax:
Practice Address - Street 1:11404 OLD GEORGETOWN RD
Practice Address - Street 2:#204
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2865
Practice Address - Country:US
Practice Address - Phone:301-770-1447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15385122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist