Active NPI
Alexandra V Brennan, DMD
- Pediatric Dentistry
- Bozrah, CT
National Provider Identifier
1205190022
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 11364
- Practice address
- 392 Salem TPK
Bozrah, CT 06334 - Phone
- (860) 886-5576
- Fax
- (860) 885-1379
- NPI assigned
- Jun 26, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 11364 | CT | Primary |
| Dentist | 122300000X | LD00076 | RI |
Addresses
Primary practice location
392 Salem TPK
Bozrah, CT 06334
Mailing address
392 Salem TPK
Bozrah, CT 06334
Phone (860) 886-5576
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11364 | CT | MD | Clinical Social Worker |
| LD00076 | RI | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Children'S Dental Associates of NLC, PC | Pediatric Dentistry | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatric Dentistry
- Bozrah, CT
- NPI 1225028657
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1440374400000",
"number": "1205190022",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "392 SALEM TPK",
"city": "BOZRAH",
"state": "CT",
"postal_code": "06334",
"telephone_number": "860-886-5576",
"fax_number": "860-885-1379"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "392 SALEM TPK",
"city": "BOZRAH",
"state": "CT",
"postal_code": "06334",
"telephone_number": "860-886-5576",
"fax_number": "860-885-1379"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRENNAN",
"first_name": "ALEXANDRA",
"middle_name": "V",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-06-26",
"last_updated": "2015-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "CT",
"license": "11364",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "RI",
"license": "LD00076",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bozrah, CT
- Alane M Apicelli, RDN, CDN
- Romina Badal, DMD
- Elaine Bentley Baughn, LMFT
- Heather Jo Bonitz-Moore, ATR-BC, LPC, IMH-E
- Bozrah Volunteer Fire Company Inc
- Hannah Carey
- CH Specialty Services CT PLLC
- Children'S Dental Associates of NLC, PC
- Comfort Care Medical Equipment, Inc
- Curana Health of Connecticut PLLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.