Provider Demographics
NPI:1790351096
Name:JEFFREY L BRENNER, DMD PLLC
Entity Type:Organization
Organization Name:JEFFREY L BRENNER, DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-860-9000
Mailing Address - Street 1:4 TERRY DR STE 8
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1838
Mailing Address - Country:US
Mailing Address - Phone:215-860-9000
Mailing Address - Fax:
Practice Address - Street 1:4 TERRY DR STE 8
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1838
Practice Address - Country:US
Practice Address - Phone:215-860-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental