Healthcare Provider Details

I. General information

NPI: 1265501175
Provider Name (Legal Business Name): WILLIAM MICHAEL BRENNAN JR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5133 WASHINGTON ST SUITE 4
DOWNERS GROVE IL
60515-4788
US

IV. Provider business mailing address

1516 S WABASH AVE #602
CHICAGO IL
60605-2903
US

V. Phone/Fax

Practice location:
  • Phone: 630-969-4645
  • Fax:
Mailing address:
  • Phone: 312-765-0097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: