Provider Demographics
NPI:1073806329
Name:BRENNY, COLE PETER (DDS)
Entity Type:Individual
Prefix:
First Name:COLE
Middle Name:PETER
Last Name:BRENNY
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 1:4017 DUPONT AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55409-1429
Mailing Address - Country:US
Mailing Address - Phone:612-865-8632
Mailing Address - Fax:
Practice Address - Street 1:4017 DUPONT AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55409-1429
Practice Address - Country:US
Practice Address - Phone:612-865-8632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN128021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice