Provider Demographics
NPI:1346071859
Name:BEHREND FAMILY DENTISTRY AND ASSOCIATES, S.C.
Entity type:Organization
Organization Name:BEHREND FAMILY DENTISTRY AND ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAXWELL
Authorized Official - Middle Name:WEITZEL
Authorized Official - Last Name:BEHREND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-299-3089
Mailing Address - Street 1:2713 BURRIES RD
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-9352
Mailing Address - Country:US
Mailing Address - Phone:219-299-3089
Mailing Address - Fax:
Practice Address - Street 1:2481 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:EAST TROY
Practice Address - State:WI
Practice Address - Zip Code:53120-2579
Practice Address - Country:US
Practice Address - Phone:262-642-5695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty