Healthcare Provider Details

I. General information

NPI: 1285841148
Provider Name (Legal Business Name): D BRENKERT ORTHO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7010 YELLOWTAIL RD #200
CHEYENNE WY
82009-6113
US

IV. Provider business mailing address

721 DARTMOUTH TRL
FORT COLLINS CO
80525-1522
US

V. Phone/Fax

Practice location:
  • Phone: 307-638-8958
  • Fax: 970-482-4980
Mailing address:
  • Phone: 970-482-4980
  • Fax: 970-482-4980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number962
License Number StateWY

VIII. Authorized Official

Name: DENNIS RICHARD BRENKERT
Title or Position: MEMBER
Credential: DDS, MS
Phone: 307-638-8958