Provider Demographics
NPI:1285791897
Name:DRENNEN, LINDA D (DMD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:D
Last Name:DRENNEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 MAIN STREET
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-2526
Mailing Address - Country:US
Mailing Address - Phone:508-478-7445
Mailing Address - Fax:508-478-6009
Practice Address - Street 1:291 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2526
Practice Address - Country:US
Practice Address - Phone:508-478-7445
Practice Address - Fax:508-478-6009
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA13696122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist