| |
215 1st Ave W Ste 100 Seattle WA 98119-4257 | |
(206) 258-4965 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 215 1st Ave W Ste 100, Seattle, Washington |
Authorized Official Name and Position | Bryan D Brenner (DOCTOR) |
Authorized Official Contact | 2062584965 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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215 1st Ave W Ste 100 Seattle WA 98119-4257 Ph: (206) 258-4965 | 215 1st Ave W Ste 100 Seattle WA 98119-4257 Ph: (206) 258-4965 |
NPI Number | 1699448324 |
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Provider Enumeration Date | 07/28/2021 |
Last Update Date | 07/29/2021 |
Medicare PECOS PAC ID | 2264838788 |
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Medicare Enrollment ID | O20210909000913 |
Identifier | Type | State | Issuer |
---|---|---|---|
1699448324 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | (* (Not Available)) | Secondary |
261QS0112X | Clinic/center - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
Provider Name | Bryan D Brenner |
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Provider Type | Practitioner - Dentist |
Provider Identifiers | NPI Number: 1982618070 PECOS PAC ID: 3678875564 Enrollment ID: I20200804003334 |
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