Provider Demographics
NPI:1619259124
Name:BEHRENS, BRENNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENNA
Middle Name:
Last Name:BEHRENS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 VERMONT DR
Mailing Address - Street 2:APARTMENT G203
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-6173
Mailing Address - Country:US
Mailing Address - Phone:712-210-0833
Mailing Address - Fax:
Practice Address - Street 1:1102 E LINCOLN AVE UNIT B
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-2521
Practice Address - Country:US
Practice Address - Phone:970-224-2688
Practice Address - Fax:970-224-2868
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO105481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice