Provider Demographics
NPI:1417096140
Name:RONALD C BRENNER
Entity Type:Organization
Organization Name:RONALD C BRENNER
Other - Org Name:NEW BOSTON DENTAL CARE, PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-487-2106
Mailing Address - Street 1:52 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:NH
Mailing Address - Zip Code:03070-4027
Mailing Address - Country:US
Mailing Address - Phone:603-487-2106
Mailing Address - Fax:603-487-2337
Practice Address - Street 1:52 HIGH ST
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:NH
Practice Address - Zip Code:03070-4027
Practice Address - Country:US
Practice Address - Phone:603-487-2106
Practice Address - Fax:603-487-2337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH16901223G0001X
NH34241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30313625Medicaid