Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 8797 | NC |
NPI | 1154550796 |
---|---|
Provider Name | Dr. Michael John Brenegan |
First Address | Cary, NC 27513-3585 |
Second Address | Cary, NC 27513-3585 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2009 |
Last Update Date | 03/07/2009 |