Brandon James Penaz, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

13072 Issued in MN

Practice address

8775 Airport Rd
Waconia, MN 55387-9634

Phone

(952) 239-2664

NPI assigned

May 4, 2012

Last updated

Jun 29, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1336089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340928000000",
    "number": "1538428909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8775 AIRPORT RD",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553879634",
            "telephone_number": "952-239-2664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8775 AIRPORT RD",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553879634",
            "telephone_number": "952-239-2664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENAZ",
        "first_name": "BRANDON",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-04",
        "last_updated": "2012-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "13072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Palmer, FNP
• Emily Palyan, MS
• Cheryl Victoria Paulaha, LICSW
• William R Peglow, MD
• John Michael Peitersen, MD
• Abbigail Pepka
• Brittney J Perlich, CCC - SLP
• Kelly Ann Peters, MA OTR/L
• Kirstin Amber Peters, MS, OTR/L
• Gregory Matthew Peterson, M.D.

• Dentist in Waconia, MN
• Providers in Waconia, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.