Healthcare Provider Details

I. General information

NPI: 1699696567
Provider Name (Legal Business Name): DR. BRENDON ROSS FUHR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 CAPEHART RD
OFFUTT AFB NE
68113-1043
US

IV. Provider business mailing address

2501 CAPEHART RD
OFFUTT AFB NE
68113
US

V. Phone/Fax

Practice location:
  • Phone: 402-232-2273
  • Fax:
Mailing address:
  • Phone: 412-294-3212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113396
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: