Healthcare Provider Details

I. General information

NPI: 1609708379
Provider Name (Legal Business Name): BRENTYN ISABELLE DODD DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 HIGHWAY 22
WEWAHITCHKA FL
32465-3237
US

IV. Provider business mailing address

403 E 11TH ST
PANAMA CITY FL
32401-3409
US

V. Phone/Fax

Practice location:
  • Phone: 850-639-2028
  • Fax: 850-639-2007
Mailing address:
  • Phone: 850-747-5599
  • Fax: 850-872-4131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN31663
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: