Provider Demographics
NPI:1629028717
Name:BREND, ARLISS L (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARLISS
Middle Name:L
Last Name:BREND
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 1:207 E FRONT AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5596
Mailing Address - Country:US
Mailing Address - Phone:701-222-4111
Mailing Address - Fax:701-222-3495
Practice Address - Street 1:810 E ROSSER AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4463
Practice Address - Country:US
Practice Address - Phone:701-222-4111
Practice Address - Fax:701-222-3495
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1615122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
793983OtherUNITED CONCORDIA
ND40007Medicaid
NDND1615OtherBLUE CROSS BLUE SHIELD OF ND