Provider Demographics
NPI:1336208511
Name:BRENNAN ORTHODONTICS, INC.
Entity Type:Organization
Organization Name:BRENNAN ORTHODONTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-463-6350
Mailing Address - Street 1:1434 WARWICK AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-5026
Mailing Address - Country:US
Mailing Address - Phone:401-463-6350
Mailing Address - Fax:401-463-5130
Practice Address - Street 1:1434 WARWICK AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-5026
Practice Address - Country:US
Practice Address - Phone:401-463-6350
Practice Address - Fax:401-463-5130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN025871223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI139-741OtherUNITED CONCORDIA
RIRG0069OtherBLUE CROSS OF MA
RI8037-4OtherBLUE CROSS
RIWB01101Medicaid
RI41-00012OtherUNITED HEALTHCARE