MEDICARE: DR. WILLIAM MICHAEL BRENNAN JR. D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist		IL

General Provider Information

NPI Number	:	1265501175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM MICHAEL BRENNAN JR. D.D.S.

Provider Business Mailing Address
First Line	:	1516 S WABASH AVE
Second Line	:	#602
City	:	CHICAGO
State	:	IL
Zip	:	60605-2903
Country	:	US
Telephone Number	:	312-765-0097
Fax Number	:

Provider Business Practice Location Address
First Line	:	5133 WASHINGTON ST
Second Line	:	SUITE 4
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-4788
Country	:	US
Telephone Number	:	630-969-4645
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/08/2007

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