Provider Demographics
NPI:1477113959
Name:BOERM, BRENDON THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENDON
Middle Name:THOMAS
Last Name:BOERM
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 1:5005 ALGONQUIN DR APT 2
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-8019
Mailing Address - Country:US
Mailing Address - Phone:641-751-1041
Mailing Address - Fax:
Practice Address - Street 1:410 HIGHWAY 218 N
Practice Address - Street 2:
Practice Address - City:LA PORTE CITY
Practice Address - State:IA
Practice Address - Zip Code:50651-1032
Practice Address - Country:US
Practice Address - Phone:319-342-3622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-096541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice