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General NPI Number Information
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NPI Number | 1790303931
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Entity Type | Individual
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Provider Name | BRENNAN BISH DDS
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Gender | Male
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Dates
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Enumeration Date | 07/13/2020
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Last Update Date | 07/13/2020
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Provider Practice Location Address
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Address Line | 451 KINETIC DR
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City | HUNTINGTON
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State | WV
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Zip | 25701-5270
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Country | US
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Telephone | 304-781-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 113 SOUTHBROOKE DR
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City | HURRICANE
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State | WV
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Zip | 25526-9070
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Country | US
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Telephone | 304-550-9311
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 4480
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License Number State | WV
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