Provider Demographics
NPI:1558563940
Name:BRENNAN, DEBORAH (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 W CHESTER PIKE
Mailing Address - Street 2:1000 A
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-1907
Mailing Address - Country:US
Mailing Address - Phone:610-356-5533
Mailing Address - Fax:610-356-2395
Practice Address - Street 1:3400 W CHESTER PIKE
Practice Address - Street 2:1000 A
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-1907
Practice Address - Country:US
Practice Address - Phone:610-356-5533
Practice Address - Fax:610-356-2395
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021767L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice