Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 36227 | CA |
NPI | 1063510022 |
---|---|
Provider Name | Dr. Peter H Brenn |
First Address | Burbank, CA 91506-2409 |
Second Address | Burbank, CA 91506-2409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 08/07/2007 |