Provider Demographics
NPI:1306865076
Name:BRENNAN, EDWARD J (DDS)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:BRENNAN
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 1:15915 S CRYSTAL CREEK DR STE B
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-9381
Mailing Address - Country:US
Mailing Address - Phone:708-301-8660
Mailing Address - Fax:708-301-8661
Practice Address - Street 1:15915 S CRYSTAL CREEK DR STE B
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-9381
Practice Address - Country:US
Practice Address - Phone:708-301-8660
Practice Address - Fax:708-301-8661
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice