Provider Demographics
NPI:1821374125
Name:BRENNAN, KARI DAWN (RDH)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:DAWN
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 W 14TH
Mailing Address - Street 2:BUILDING C
Mailing Address - City:RIFLE
Mailing Address - State:CO
Mailing Address - Zip Code:81650-4700
Mailing Address - Country:US
Mailing Address - Phone:970-945-2840
Mailing Address - Fax:
Practice Address - Street 1:195 W 14TH
Practice Address - Street 2:BUILDING C
Practice Address - City:RIFLE
Practice Address - State:CO
Practice Address - Zip Code:81650-4700
Practice Address - Country:US
Practice Address - Phone:970-945-2840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO905168124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist