Provider Demographics
NPI:1801947718
Name:SONGSTAD, BRENT M (DDS)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:M
Last Name:SONGSTAD
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 1:3819 CLEGHORN AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2507
Mailing Address - Country:US
Mailing Address - Phone:615-383-2242
Mailing Address - Fax:615-383-9738
Practice Address - Street 1:3819 CLEGHORN AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2507
Practice Address - Country:US
Practice Address - Phone:615-383-2242
Practice Address - Fax:615-383-9738
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNBS75331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice