Provider Demographics
NPI:1265449011
Name:BRENNAN, DANIEL M (DMD)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:M
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:674 ROGERS ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-3836
Mailing Address - Country:US
Mailing Address - Phone:978-459-0594
Mailing Address - Fax:978-459-0664
Practice Address - Street 1:674 ROGERS ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-3836
Practice Address - Country:US
Practice Address - Phone:978-459-0594
Practice Address - Fax:978-459-0664
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA109001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice