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General NPI Number Information
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NPI Number | 1538348321
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Entity Type | Individual
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Provider Name | MATTHEW M BRENNAN D.M.D
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Gender | Male
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Dates
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Enumeration Date | 10/29/2007
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Last Update Date | 10/29/2007
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Provider Practice Location Address
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Address Line | 1434 WARWICK AVE
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City | WARWICK
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State | RI
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Zip | 02888-5026
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Country | US
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Telephone | 401-463-6350
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Fax |
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Provider Business Mailing Address
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Address Line | 1434 WARWICK AVE
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City | WARWICK
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State | RI
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Zip | 02888-5026
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Country | US
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Telephone |
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Fax |
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DEN2587
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License Number State | RI
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