Provider Demographics
NPI:1821374125
Name:BRENNAN, KARI DAWN (RDH)
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:DAWN
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 1:439 COUNTY ROAD 26
Mailing Address - Street 2:
Mailing Address - City:RIFLE
Mailing Address - State:CO
Mailing Address - Zip Code:81650-8820
Mailing Address - Country:US
Mailing Address - Phone:970-878-4091
Mailing Address - Fax:
Practice Address - Street 1:729 WATER ST
Practice Address - Street 2:
Practice Address - City:MEEKER
Practice Address - State:CO
Practice Address - Zip Code:81641-3400
Practice Address - Country:US
Practice Address - Phone:970-878-9967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.000905168124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO53200314Medicaid