Provider Demographics
NPI:1831125426
Name:DERENZY, BROOK A (DDS)
Entity Type:Individual
Prefix:DR
First Name:BROOK
Middle Name:A
Last Name:DERENZY
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 1:1553 NW CANAL BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-1341
Mailing Address - Country:US
Mailing Address - Phone:541-923-2880
Mailing Address - Fax:541-923-2881
Practice Address - Street 1:1553 NW CANAL BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1341
Practice Address - Country:US
Practice Address - Phone:541-923-2880
Practice Address - Fax:541-923-2881
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD82871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice