Provider Demographics
NPI:1952504870
Name:BRENNER, LEONARD J (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:J
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 1:870 CHANNEL RD
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1843
Mailing Address - Country:US
Mailing Address - Phone:718-648-3317
Mailing Address - Fax:
Practice Address - Street 1:108 W END AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4809
Practice Address - Country:US
Practice Address - Phone:718-648-3317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0340411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice