Provider Demographics
NPI:1417032665
Name:BRENNER, ALLAN STUART (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:STUART
Last Name:BRENNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 CHURCH RD
Mailing Address - Street 2:ROBERTS MILL SHOPPING PLAZA
Mailing Address - City:MT. LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054
Mailing Address - Country:US
Mailing Address - Phone:856-234-1766
Mailing Address - Fax:856-234-1766
Practice Address - Street 1:3701 CHURCH RD
Practice Address - Street 2:ROBERTS MILL SHOPPING PLAZA
Practice Address - City:MT. LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054
Practice Address - Country:US
Practice Address - Phone:856-234-1766
Practice Address - Fax:856-234-1766
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ98951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice