Healthcare Provider Details

I. General information

NPI: 1144899105
Provider Name (Legal Business Name): BRENT HARNEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 700 MEDDAC-B DENTAL
VILSECK BAYERN
09112
DE

IV. Provider business mailing address

PSC 411 BOX 964
APO AE
09112-0010
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10611
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10611
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: