Provider Demographics
NPI:1124836473
Name:BRENNAN, EMILY MARIE (RDH)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:MARIE
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23349 RED OAK CT
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619-4070
Mailing Address - Country:US
Mailing Address - Phone:240-561-3713
Mailing Address - Fax:
Practice Address - Street 1:23076 THREE NOTCH RD STE 203
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MD
Practice Address - Zip Code:20619-2491
Practice Address - Country:US
Practice Address - Phone:240-349-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD8352124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist