Provider Demographics
NPI:1962180646
Name:BRENNAN, JONATHAN PIERCE (DDS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:PIERCE
Last Name:BRENNAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 W LAKE ST UNIT 734
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2183
Mailing Address - Country:US
Mailing Address - Phone:630-464-0296
Mailing Address - Fax:
Practice Address - Street 1:1515 SAINT FRANCIS AVE STE 145
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-4307
Practice Address - Country:US
Practice Address - Phone:952-496-1538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND149711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice