Provider Demographics
NPI:1992044119
Name:MCLAIN, BRENNA GOODWIN (DDS)
Entity Type:Individual
Prefix:
First Name:BRENNA
Middle Name:GOODWIN
Last Name:MCLAIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:BRENNA
Other - Middle Name:MICHELLE
Other - Last Name:GOODWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3740 DACORO LN STE 140
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-2504
Mailing Address - Country:US
Mailing Address - Phone:303-688-6630
Mailing Address - Fax:303-663-6534
Practice Address - Street 1:3740 DACORO LN STE 140
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-2504
Practice Address - Country:US
Practice Address - Phone:303-688-6630
Practice Address - Fax:303-663-6534
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00103693122300000X
390200000X
CO00203696122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program