Provider Demographics
NPI:1053652941
Name:SANDRA BRENER DSS PA
Entity Type:Organization
Organization Name:SANDRA BRENER DSS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:ROSA
Authorized Official - Last Name:BRENER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-441-3777
Mailing Address - Street 1:9720 STIRLING RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-8013
Mailing Address - Country:US
Mailing Address - Phone:954-441-3777
Mailing Address - Fax:
Practice Address - Street 1:9720 STIRLING RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-8013
Practice Address - Country:US
Practice Address - Phone:954-441-3777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-03
Last Update Date:2013-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN185991223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty