Provider Demographics
NPI:1467877290
Name:O'ROURKE, BRENDAN MICHAEL (DDS)
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:MICHAEL
Last Name:O'ROURKE
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 1:270-05 76TH AVENUE
Mailing Address - Street 2:DEPT. OF DENTAL MEDICINE/ORAL AND MAXILLOFACIAL SURGERY
Mailing Address - City:NEW HYDE PARK, NY
Mailing Address - State:NY
Mailing Address - Zip Code:11040
Mailing Address - Country:US
Mailing Address - Phone:718-470-4120
Mailing Address - Fax:718-347-3483
Practice Address - Street 1:27005 76TH AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1402
Practice Address - Country:US
Practice Address - Phone:718-470-4120
Practice Address - Fax:718-347-3483
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-03
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program