Provider Demographics
NPI:1457607707
Name:BREND, MEGAN LEE (DMD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LEE
Last Name:BREND
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 W TURNPIKE AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-8115
Mailing Address - Country:US
Mailing Address - Phone:701-255-2467
Mailing Address - Fax:
Practice Address - Street 1:1143 W TURNPIKE AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-8115
Practice Address - Country:US
Practice Address - Phone:701-255-2467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND21371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice