MEDICARE: WILLIAM MICHAEL BRENNAN SR. DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	19A15602	IL

General Provider Information

NPI Number	:	1235142746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM MICHAEL BRENNAN SR. DDS

Provider Business Mailing Address
First Line	:	5133 WASHINGTON ST
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515
Country	:	US
Telephone Number	:	630-969-4645
Fax Number	:

Provider Business Practice Location Address
First Line	:	5133 WASHINGTON ST
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515
Country	:	US
Telephone Number	:	630-969-4645
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	07/08/2007

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