Provider Demographics
NPI:1790985513
Name:DRENNAN, MICHAEL ROSS (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROSS
Last Name:DRENNAN
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 1:220 SHOPS BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLOW PARK
Mailing Address - State:TX
Mailing Address - Zip Code:76087
Mailing Address - Country:US
Mailing Address - Phone:817-441-7654
Mailing Address - Fax:817-441-6168
Practice Address - Street 1:220 SHOPS BLVD
Practice Address - Street 2:
Practice Address - City:WILLOW PARK
Practice Address - State:TX
Practice Address - Zip Code:76087-4375
Practice Address - Country:US
Practice Address - Phone:817-441-7654
Practice Address - Fax:817-441-6168
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23408122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist