Provider Demographics
NPI:1821016437
Name:BRENDLINGER, ERIC JON (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JON
Last Name:BRENDLINGER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DAYTON VA MEDICAL CENTER
Mailing Address - Street 2:4100 WEST THIRD STREET
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45428
Mailing Address - Country:US
Mailing Address - Phone:937-268-6511
Mailing Address - Fax:
Practice Address - Street 1:DAYTON VA MEDICAL CENTER
Practice Address - Street 2:4100 WEST THIRD STREET
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45428
Practice Address - Country:US
Practice Address - Phone:937-268-6511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024634L1223X0400X
OH30-0243891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics