Provider Demographics
NPI:1942668033
Name:BRENNAN, RYAN JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JAMES
Last Name:BRENNAN
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 1:5050 MAIN ST
Mailing Address - Street 2:APT # 801
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-2782
Mailing Address - Country:US
Mailing Address - Phone:314-591-4376
Mailing Address - Fax:
Practice Address - Street 1:5050 MAIN ST
Practice Address - Street 2:APT # 801
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-2782
Practice Address - Country:US
Practice Address - Phone:314-591-4376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20160012091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice