Provider Demographics
NPI:1285970897
Name:WILLIAM BEHRNDT D.M.D
Entity type:Organization
Organization Name:WILLIAM BEHRNDT D.M.D
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIVETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-659-7676
Mailing Address - Street 1:3030 SE MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-6637
Mailing Address - Country:US
Mailing Address - Phone:503-659-7676
Mailing Address - Fax:503-654-3303
Practice Address - Street 1:3030 SE MONROE ST
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-6637
Practice Address - Country:US
Practice Address - Phone:503-659-7676
Practice Address - Fax:503-654-3303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-31
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7371261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental