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General NPI Number Information
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NPI Number | 1366960445
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Entity Type | Individual
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Provider Name | CHELSEA L BRENNECKE DDS
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Gender | Female
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Dates
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Enumeration Date | 09/08/2017
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Last Update Date | 10/14/2022
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Provider Practice Location Address
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Address Line | 201 COLORADO AVE STE 201
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City | MONTROSE
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State | CO
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Zip | 81401-3630
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Country | US
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Telephone | 970-249-1898
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Fax | 970-240-3277
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Provider Business Mailing Address
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Address Line | 154 COLORADO AVE STE 201
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City | MONTROSE
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State | CO
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Zip | 81401-3652
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Country | US
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Telephone | 970-249-1898
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Fax | 970-240-3277
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12012821A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 203591
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License Number State | CO
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