Provider Demographics
NPI:1740267517
Name:BRENYO, MICHAEL RODERICK (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RODERICK
Last Name:BRENYO
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:PSC 557, BOX 1207
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96379-1207
Mailing Address - Country:JP
Mailing Address - Phone:01181611-746-8298
Mailing Address - Fax:
Practice Address - Street 1:PSC 557, BOX 1207
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96379-1207
Practice Address - Country:JP
Practice Address - Phone:01181611-746-8298
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD103871223P0700X
PADS024094L1223P0700X
VA04010084191223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223P0700XDental ProvidersDentistProsthodontics