MEDICARE: DR. BRYAN DOUGLAS BRENNER 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	1223G0001X	General Practice Dentistry	08337	IA
2	122300000X	Dentist	DE60103984	WA

General Provider Information

NPI Number	:	1982618070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN DOUGLAS BRENNER D.D.S.

Provider Business Mailing Address
First Line	:	10254 16TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98146-1432
Country	:	US
Telephone Number	:	206-762-2573
Fax Number	:	206-763-0291

Provider Business Practice Location Address
First Line	:	10254 16TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98146-1432
Country	:	US
Telephone Number	:	206-762-2573
Fax Number	:	206-763-0291

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	07/23/2021

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