Provider Demographics
NPI:1679202154
Name:JORDAN AND KEGAN BRENNER, DDS, PLLC
Entity type:Organization
Organization Name:JORDAN AND KEGAN BRENNER, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:307-286-3956
Mailing Address - Street 1:110 W 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-1347
Mailing Address - Country:US
Mailing Address - Phone:307-286-3956
Mailing Address - Fax:
Practice Address - Street 1:1169 HILLTOP PKWY
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-3173
Practice Address - Country:US
Practice Address - Phone:307-286-3956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental