Provider Demographics
NPI:1184385593
Name:BRENNA MCLAIN, DDS, PLLC
Entity type:Organization
Organization Name:BRENNA MCLAIN, DDS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-688-6630
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 1:850 W HAPPY CANYON RD
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-3908
Practice Address - Country:US
Practice Address - Phone:303-688-6630
Practice Address - Fax:303-663-6534
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRENNA MCLAIN, DDS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-07
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODEN.00203696OtherCO DEPARTMENT OF REGULATORY AFFAIRS;DIV OF PROFESSIONS AND OCCUPATIONS
CODEN.00203696OtherCO DEPARTMENT OF REGULATORY AFFAIRS;DIV OF PROFESSIONS AND OCCUPATIONS