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General NPI Number Information
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NPI Number | 1942748140
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Entity Type | Individual
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Provider Name | ALISHA DIANE BRENNEN D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 02/08/2017
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 10201 MARTIN LUTHER KING JR HWY UNIT 240A
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City | BOWIE
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State | MD
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Zip | 20720-4003
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Country | US
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Telephone | 240-764-5753
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Fax | 240-764-5799
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Provider Business Mailing Address
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Address Line | 3420 TOLEDO TER APT 320
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City | HYATTSVILLE
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State | MD
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Zip | 20782-4207
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Country | US
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Telephone | 952-262-9328
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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 | 16215
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 16215
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License Number State | MD
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