Healthcare Provider Details

I. General information

NPI: 1205764438
Provider Name (Legal Business Name): BRENDAN TYLER EDMONDS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1063 S STATE RD STE 3
DAVISON MI
48423-1900
US

IV. Provider business mailing address

9345 TIGER RUN TRL
DAVISON MI
48423-8430
US

V. Phone/Fax

Practice location:
  • Phone: 810-658-2020
  • Fax:
Mailing address:
  • Phone: 810-449-7939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: