Provider Demographics
NPI:1063224038
Name:BRENSON, DAMON DALE-EDWARD
Entity type:Individual
Prefix:
First Name:DAMON
Middle Name:DALE-EDWARD
Last Name:BRENSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 BRONSON AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-1827
Mailing Address - Country:US
Mailing Address - Phone:567-315-5269
Mailing Address - Fax:
Practice Address - Street 1:235 BRONSON AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-1827
Practice Address - Country:US
Practice Address - Phone:567-315-5269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor