MEDICARE: BRENNAN ERTL

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	DS044780	PA

General Provider Information

NPI Number	:	1285471425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENNAN ERTL

Provider Business Mailing Address
First Line	:	124 GIDEON DR
Second Line	:
City	:	KENNETT SQUARE
State	:	PA
Zip	:	19348-1554
Country	:	US
Telephone Number	:	916-207-5518
Fax Number	:

Provider Business Practice Location Address
First Line	:	306 LIMESTONE RD
Second Line	:
City	:	OXFORD
State	:	PA
Zip	:	19363-1233
Country	:	US
Telephone Number	:	610-753-4506
Fax Number	:

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

Provider Enumeration Date	:	07/15/2024
Last Update Date	:	07/15/2024

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Directions to “ BRENNAN ERTL ” Practice Location

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