Healthcare Provider Details

I. General information

NPI: 1285752998
Provider Name (Legal Business Name): BRETT BARRY BENDER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 W COLLEGE ST
BOZEMAN MT
59718-4061
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 406-587-4432
  • Fax: 406-587-7015
Mailing address:
  • Phone: 920-663-9008
  • Fax: 920-684-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMED-PHYS-LIC-167368
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number5101016359
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: