Provider Demographics
NPI:1255433363
Name:CARR, BREN MONTGOMERY (DDS)
Entity type:Individual
Prefix:DR
First Name:BREN
Middle Name:MONTGOMERY
Last Name:CARR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20475 STATE HIGHWAY 46 W
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070-6146
Mailing Address - Country:US
Mailing Address - Phone:830-438-7444
Mailing Address - Fax:830-438-7112
Practice Address - Street 1:20475 STATE HIGHWAY 46 W
Practice Address - Street 2:SUITE 310
Practice Address - City:SPRING BRANCH
Practice Address - State:TX
Practice Address - Zip Code:78070-6146
Practice Address - Country:US
Practice Address - Phone:830-438-7444
Practice Address - Fax:830-438-7112
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX147911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14791OtherDENTAL LISCENSE