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General NPI Number Information
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NPI Number | 1831752880
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Entity Type | Individual
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Provider Name | BRENNAN REE BAHNSON DMD
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Gender | Male
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Dates
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Enumeration Date | 04/16/2019
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 127 NE EADS ST
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City | NEWPORT
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State | OR
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Zip | 97365-2840
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Country | US
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Telephone | 541-265-9466
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Fax |
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Provider Business Mailing Address
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Address Line | 60 BARRE CIR
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City | CHICOPEE
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State | MA
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Zip | 01013-3243
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Country | US
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Telephone | 307-299-5419
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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 | DN1858235
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D11451
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License Number State | OR
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