Provider Demographics
NPI:1124190699
Name:BRENZA, TINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:
Last Name:BRENZA
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 1:6012 PASEO PALMILLA
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-1717
Mailing Address - Country:US
Mailing Address - Phone:815-621-1021
Mailing Address - Fax:
Practice Address - Street 1:6012 PASEO PALMILLA
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-1717
Practice Address - Country:US
Practice Address - Phone:815-621-1021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0247631223G0001X
CADDS1033921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice