Provider Demographics
NPI:1760521504
Name:BRENNER, ISRAEL (DMD)
Entity Type:Individual
Prefix:
First Name:ISRAEL
Middle Name:
Last Name:BRENNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 PANORAMA DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-4418
Mailing Address - Country:US
Mailing Address - Phone:631-271-3065
Mailing Address - Fax:631-271-3461
Practice Address - Street 1:14 W NECK RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2619
Practice Address - Country:US
Practice Address - Phone:631-271-1770
Practice Address - Fax:631-271-3461
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032914122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist