MEDICARE: BRENNAN RILEY TRUMAN DMD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	7841	NV

General Provider Information

NPI Number	:	1558061663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENNAN RILEY TRUMAN DMD

Provider Business Mailing Address
First Line	:	9500 OJIBWA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-0503
Country	:	US
Telephone Number	:	702-371-6891
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 OJIBWA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-0503
Country	:	US
Telephone Number	:	702-371-6891
Fax Number	:

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

Provider Enumeration Date	:	03/07/2023
Last Update Date	:	07/03/2023

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