Healthcare Provider Details

I. General information

NPI: 1326255365
Provider Name (Legal Business Name): DENNIS RICHARD BRENKERT DDS,MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S SHIELDS ST BLDG A , SUITE 100
FORT COLLINS CO
80526-1827
US

IV. Provider business mailing address

721 DARTMOUTH TRL
FORT COLLINS CO
80525-1522
US

V. Phone/Fax

Practice location:
  • Phone: 970-484-0250
  • Fax: 970-482-4980
Mailing address:
  • Phone: 970-482-4980
  • Fax: 970-482-4980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number332
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: