Healthcare Provider Details

I. General information

NPI: 1598761884
Provider Name (Legal Business Name): JAMES J. BRENNAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 CREPEAU BLVD
CUMBERLAND RI
02864-2107
US

IV. Provider business mailing address

8 CREPEAU BLVD
CUMBERLAND RI
02864-2107
US

V. Phone/Fax

Practice location:
  • Phone: 401-658-1116
  • Fax: 401-658-1117
Mailing address:
  • Phone: 401-658-1116
  • Fax: 401-658-1117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1538
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: