Provider Demographics
NPI:1063510022
Name:BRENN, PETER H (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:H
Last Name:BRENN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 W OLIVE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2409
Mailing Address - Country:US
Mailing Address - Phone:818-563-3825
Mailing Address - Fax:818-563-3047
Practice Address - Street 1:1400 W OLIVE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-2409
Practice Address - Country:US
Practice Address - Phone:818-563-3825
Practice Address - Fax:818-563-3047
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA362271223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics