=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821374125
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARI DAWN BRENNAN R.D.H.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2011
-----------------------------------------------------
Last Update Date | 10/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 729 WATER ST
-----------------------------------------------------
City | MEEKER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81641-3400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-878-9967
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 439 COUNTY ROAD 26
-----------------------------------------------------
City | RIFLE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81650-8820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-878-4091
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | DH.000905168
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------