=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891914495
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRENNAN HUGHES D.M.D APC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14526 ROSCOE BLVD
-----------------------------------------------------
City | PANORAMA CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91402-4176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-893-7858
-----------------------------------------------------
Fax | 818-893-6803
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14526 ROSCOE BLVD
-----------------------------------------------------
City | PANORAMA CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91402-4176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-893-7858
-----------------------------------------------------
Fax | 818-893-6803
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. BRENNAN L. HUGHES
-----------------------------------------------------
Credential | D.M.D
-----------------------------------------------------
Telephone | 818-893-7858
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 39280
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------