Provider Demographics
NPI:1891057030
Name:BRENNAN, JONATHAN JAY (MD, DMD, MPH)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:JAY
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:MD, DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1929 E. RAY RD.
Mailing Address - Street 2:STE 2
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225
Mailing Address - Country:US
Mailing Address - Phone:480-498-8825
Mailing Address - Fax:480-498-8826
Practice Address - Street 1:1929 E. RAY RD.
Practice Address - Street 2:STE 2
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225
Practice Address - Country:US
Practice Address - Phone:480-498-8825
Practice Address - Fax:480-498-8826
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0084851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice