Provider Demographics
NPI:1043053507
Name:BRINGEDAHL, BRANDON MATTHEW (DDS)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:MATTHEW
Last Name:BRINGEDAHL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5978 HARVEY ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-6720
Mailing Address - Country:US
Mailing Address - Phone:231-799-0404
Mailing Address - Fax:
Practice Address - Street 1:5978 HARVEY ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-6720
Practice Address - Country:US
Practice Address - Phone:231-799-0404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016021111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty