Provider Demographics
NPI:1851964639
Name:BEHRENDT, ZACHARY J (DDS)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:J
Last Name:BEHRENDT
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 1:2575 CORAL CT
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2811
Mailing Address - Country:US
Mailing Address - Phone:319-545-2345
Mailing Address - Fax:319-545-2345
Practice Address - Street 1:2575 CORAL CT
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2811
Practice Address - Country:US
Practice Address - Phone:319-545-2345
Practice Address - Fax:319-545-2349
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA098921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA09892Medicaid