Healthcare Provider Details

I. General information

NPI: 1861328197
Provider Name (Legal Business Name): BRENDAN DUFFY III DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 S DRAKE RD
KALAMAZOO MI
49009-1216
US

IV. Provider business mailing address

5185 GRAND ARBRE TRL
PORTAGE MI
49024-5765
US

V. Phone/Fax

Practice location:
  • Phone: 269-344-7222
  • Fax:
Mailing address:
  • Phone: 269-903-9697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901603187
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: