MEDICARE: D BRENKERT ORTHO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	962	WY

General Provider Information

NPI Number	:	1285841148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D BRENKERT ORTHO LLC

Provider Business Mailing Address
First Line	:	721 DARTMOUTH TRL
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1522
Country	:	US
Telephone Number	:	970-482-4980
Fax Number	:	970-482-4980

Provider Business Practice Location Address
First Line	:	7010 YELLOWTAIL RD
Second Line	:	#200
City	:	CHEYENNE
State	:	WY
Zip	:	82009-6113
Country	:	US
Telephone Number	:	307-638-8958
Fax Number	:	970-482-4980

Authorized Official
Title or Position	:	MEMBER
Name	:	DENNIS RICHARD BRENKERT
Credential	:	DDS, MS
Telephone Number	:	307-638-8958

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	08/22/2020

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