Healthcare Provider Details

I. General information

NPI: 1124836473
Provider Name (Legal Business Name): EMILY MARIE BRENNAN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23076 THREE NOTCH RD STE 203
CALIFORNIA MD
20619-2491
US

IV. Provider business mailing address

23349 RED OAK CT
CALIFORNIA MD
20619-4070
US

V. Phone/Fax

Practice location:
  • Phone: 240-349-5000
  • Fax:
Mailing address:
  • Phone: 240-561-3713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number8352
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: