Provider Demographics
NPI:1952797938
Name:BEHRNDT DENTAL SERVICES PC
Entity Type:Organization
Organization Name:BEHRNDT DENTAL SERVICES PC
Other - Org Name:RUTLEDGE FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:FELSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-557-7374
Mailing Address - Street 1:126 FAIRPLAY ST
Mailing Address - Street 2:
Mailing Address - City:RUTLEDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30663-2378
Mailing Address - Country:US
Mailing Address - Phone:706-557-7374
Mailing Address - Fax:
Practice Address - Street 1:126 FAIRPLAY ST
Practice Address - Street 2:
Practice Address - City:RUTLEDGE
Practice Address - State:GA
Practice Address - Zip Code:30663-2378
Practice Address - Country:US
Practice Address - Phone:706-557-7374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014716122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty