Provider Demographics
NPI:1851920755
Name:BRENNAN, ALLYSON CHRISTINE (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:ALLYSON
Middle Name:CHRISTINE
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 512
Mailing Address - Street 2:
Mailing Address - City:STORMVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12582-0512
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:69 OLD TEMPLE HILL RD
Practice Address - Street 2:
Practice Address - City:VAILS GATE
Practice Address - State:NY
Practice Address - Zip Code:12584
Practice Address - Country:US
Practice Address - Phone:845-562-2063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0630691223X0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program