Provider Demographics
NPI:1558061663
Name:TRUMAN, BRENNAN RILEY (DMD)
Entity Type:Individual
Prefix:
First Name:BRENNAN
Middle Name:RILEY
Last Name:TRUMAN
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 1:9500 OJIBWA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-0503
Mailing Address - Country:US
Mailing Address - Phone:702-371-6891
Mailing Address - Fax:
Practice Address - Street 1:9500 OJIBWA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-0503
Practice Address - Country:US
Practice Address - Phone:702-371-6891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NV78411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program