Provider Demographics
NPI:1902924335
Name:HAMRICK-STOTTS, BRENNA LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENNA
Middle Name:LEE
Last Name:HAMRICK-STOTTS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 BROOKSIDE AVE
Mailing Address - Street 2:SUITE T
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-6300
Mailing Address - Country:US
Mailing Address - Phone:909-793-9711
Mailing Address - Fax:909-792-0887
Practice Address - Street 1:1150 BROOKSIDE AVE
Practice Address - Street 2:SUITE T
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-6300
Practice Address - Country:US
Practice Address - Phone:909-793-9711
Practice Address - Fax:909-792-0887
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA352641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice