Provider Demographics
NPI:1053548511
Name:GARRISON, BRENDA KRISTINE (DDS)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:KRISTINE
Last Name:GARRISON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:BRENDA
Other - Middle Name:KRISTINE
Other - Last Name:LENSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1530 DORIS DR
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-9113
Mailing Address - Country:US
Mailing Address - Phone:920-563-9373
Mailing Address - Fax:
Practice Address - Street 1:1530 DORIS DR
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-9113
Practice Address - Country:US
Practice Address - Phone:920-563-9373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10160122300000X
WI6408-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist