Provider Demographics
NPI:1609556638
Name:REICH, BRENDAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENDAN
Middle Name:
Last Name:REICH
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 1:4601 PARK COMMONS DR APT 344
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4989
Mailing Address - Country:US
Mailing Address - Phone:719-963-1137
Mailing Address - Fax:
Practice Address - Street 1:5831 BROOKLYN BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-2521
Practice Address - Country:US
Practice Address - Phone:763-533-8669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00205634122300000X
MND14998122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist