Provider Demographics
NPI:1851478184
Name:BRENNAN, JOHN GERARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GERARD
Last Name:BRENNAN
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 1:505 WOODMERE AVE
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-5635
Mailing Address - Country:US
Mailing Address - Phone:732-988-7019
Mailing Address - Fax:
Practice Address - Street 1:2510 NOTTINGHAM WAY
Practice Address - Street 2:
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-4113
Practice Address - Country:US
Practice Address - Phone:609-587-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI206461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice