Healthcare Provider Details

I. General information

NPI: 1629028717
Provider Name (Legal Business Name): ARLISS L BREND DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 E ROSSER AVE SUITE 405
BISMARCK ND
58501-4463
US

IV. Provider business mailing address

207 E FRONT AVE SUITE C
BISMARCK ND
58504-5596
US

V. Phone/Fax

Practice location:
  • Phone: 701-222-4111
  • Fax: 701-222-3495
Mailing address:
  • Phone: 701-222-4111
  • Fax: 701-222-3495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1615
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: