Provider Demographics
NPI:1518694934
Name:BRENNAN, CHANDLER (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHANDLER
Middle Name:
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 1:822 OLD DUTCH MILL RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-3870
Mailing Address - Country:US
Mailing Address - Phone:920-901-4860
Mailing Address - Fax:
Practice Address - Street 1:7750 N UNION BLVD STE 101
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-4081
Practice Address - Country:US
Practice Address - Phone:719-598-1293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00205303122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist