Provider Demographics
NPI:1477769099
Name:BREHNAN, KENNETH (DMD MS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:BREHNAN
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1126
Mailing Address - Country:US
Mailing Address - Phone:510-525-1772
Mailing Address - Fax:510-525-3157
Practice Address - Street 1:591 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1126
Practice Address - Country:US
Practice Address - Phone:510-525-1772
Practice Address - Fax:510-525-3157
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292131223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics