Provider Demographics
NPI:1760433890
Name:BRENGMAN, DANIEL (DDS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:BRENGMAN
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 1:3825 CEDAR GROVE PKWY
Mailing Address - Street 2:SUITE 1101
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1419
Mailing Address - Country:US
Mailing Address - Phone:651-905-9090
Mailing Address - Fax:
Practice Address - Street 1:3825 CEDAR GROVE PKWY
Practice Address - Street 2:SUITE 1101
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1419
Practice Address - Country:US
Practice Address - Phone:651-905-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN99541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice