Provider Demographics
NPI:1063024370
Name:BRENNER, KEGAN J (DDS)
Entity Type:Individual
Prefix:
First Name:KEGAN
Middle Name:J
Last Name:BRENNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1169 HILLTOP PKWY UNIT 203
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-2523
Mailing Address - Country:US
Mailing Address - Phone:307-426-4014
Mailing Address - Fax:307-426-4016
Practice Address - Street 1:1169 HILLTOP PKWY UNIT 203
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-2523
Practice Address - Country:US
Practice Address - Phone:970-871-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY15551223G0001X
CO2051031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice