Provider Demographics
NPI:1699553636
Name:BRYAN DOUGLAS BRENNER PLLC
Entity type:Organization
Organization Name:BRYAN DOUGLAS BRENNER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:BRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-258-4965
Mailing Address - Street 1:215 1ST AVE W SUITE #100
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119
Mailing Address - Country:US
Mailing Address - Phone:206-258-4965
Mailing Address - Fax:206-258-4966
Practice Address - Street 1:215 1ST AVE W SUITE #100
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119
Practice Address - Country:US
Practice Address - Phone:206-258-4965
Practice Address - Fax:206-258-4966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty