Provider Demographics
NPI:1588763486
Name:DIFLORIO BRENNAN, THERESE M (DMD, MD)
Entity type:Individual
Prefix:DR
First Name:THERESE
Middle Name:M
Last Name:DIFLORIO BRENNAN
Suffix:
Gender:F
Credentials:DMD, MD
Other - Prefix:MISS
Other - First Name:THERESE
Other - Middle Name:M
Other - Last Name:DIFLORIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3655 ROUTE 202
Mailing Address - Street 2:STE 210
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18902-6602
Mailing Address - Country:US
Mailing Address - Phone:610-777-7646
Mailing Address - Fax:610-777-7570
Practice Address - Street 1:517 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:SHILLINGTON
Practice Address - State:PA
Practice Address - Zip Code:19607-1364
Practice Address - Country:US
Practice Address - Phone:610-777-7646
Practice Address - Fax:610-777-7570
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-029126-L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018523460002Medicaid
PADI1315366OtherHIGHMARK BLUE SHIELD
PA153909OtherHEALTH AM/HEALTH ASSURANC
PA9929126OtherDELTA DENTAL OF PA
PA0018523460001Medicaid
PA02261401OtherCAPITAL BLUE CROSS
PA9929126OtherDELTA DENTAL OF PA
PAH50381Medicare UPIN