Provider Demographics
NPI:1790303931
Name:BISH, BRENNAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENNAN
Middle Name:
Last Name:BISH
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 1:113 SOUTHBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9070
Mailing Address - Country:US
Mailing Address - Phone:304-550-9311
Mailing Address - Fax:
Practice Address - Street 1:451 KINETIC DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-5270
Practice Address - Country:US
Practice Address - Phone:304-781-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4480122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist