Brennen, Alisha Diane

Brennen, Alisha Diane is an sole proprietor health care provider with primary practice located at 10201 Martin Luther King Jr Hwy Unit 240A , Bowie MD 20720-4003. She recently has 2 registered licenses in different health care specialties including Dental Providers / Dentist, Dental Providers / Pediatric Dentistry. Dental Providers / Pediatric Dentistry is her primary health care specialty. Brennen, Alisha Diane can be contacted via phone (240) 764-5753.

Contact Information

Primary practice address
10201 Martin Luther King Jr Hwy Unit 240A Bowie MD 20720-4003
Phone: (240) 764-5753
Fax: (240) 764-5799
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 16215 Maryland
Dental Providers / Pediatric Dentistry 1223P0221X 16215 Maryland

Profile Details

NPI number 1942748140
LBN Legal business name Brennen, Alisha Diane
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 8th, 2017
Last updated Oct 1st, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1942748140 NPPES
Maryland MEDICAID 800126350

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