Healthcare Provider Details

I. General information

NPI: 1013335223
Provider Name (Legal Business Name): BRANDON TRIMBELL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 COMMERCE PKWY
FORT ATKINSON WI
53538-3139
US

IV. Provider business mailing address

1951 COMMERCE PKWY
FORT ATKINSON WI
53538-3139
US

V. Phone/Fax

Practice location:
  • Phone: 920-563-4415
  • Fax:
Mailing address:
  • Phone: 920-563-4415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License Number7268-15
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7268-15
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number7268-15
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number7268-15
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License Number7268-15
License Number StateWI
# 6
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number7268-15
License Number StateWI
# 7
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number7268-15
License Number StateWI
# 8
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7268-15
License Number StateWI
# 9
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number7268-15
License Number StateWI
# 10
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number7268-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: