Individual
BRENDEN KHOUNLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
715 W MILWAUKEE AVE, STORM LAKE, IA 50588-1564
(712) 213-0109
Mailing address
715 W MILWAUKEE AVE, STORM LAKE, IA 50588-1564
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DDS-09907
IA
Other
Enumeration date
06/21/2021
Last updated
06/22/2021
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