Individual
DR. BRENNAN REE BAHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
127 NE EADS ST, NEWPORT, OR 97365-2840
(541) 265-9466
Mailing address
60 BARRE CIR, CHICOPEE, MA 01013-3243
(307) 299-5419
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
D11451
OR
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
DN1858235
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D11451
OREGON BOARD OF DENTISTRY
OR
Enumeration date
04/16/2019
Last updated
10/09/2024
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