Provider Demographics
NPI:1467004291
Name:DRS. NATHANIEL AND KATHERINE BEHRENTS DDS PC
Entity Type:Organization
Organization Name:DRS. NATHANIEL AND KATHERINE BEHRENTS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BEHRENTS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
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:479-445-6942
Practice Address - Street 1:800 SE PLAZA AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7270
Practice Address - Country:US
Practice Address - Phone:479-445-6884
Practice Address - Fax:479-445-6942
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DRS. NATHANIEL AND KATHERINE BEHRENTS, DDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty