Provider Demographics
NPI:1184922718
Name:BRENNAN, ROBERT P (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:P
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 1:1940 JOHNSTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-2799
Mailing Address - Country:US
Mailing Address - Phone:610-868-2927
Mailing Address - Fax:610-868-8172
Practice Address - Street 1:1940 JOHNSTON DRIVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-2799
Practice Address - Country:US
Practice Address - Phone:610-868-2927
Practice Address - Fax:610-868-8172
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026400L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice