Provider Demographics
NPI:1265565329
Name:BRENNER, DARREN GLENN (DMD)
Entity type:Individual
Prefix:DR
First Name:DARREN
Middle Name:GLENN
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 1:3461 RTE 22
Mailing Address - Street 2:SUITE 303
Mailing Address - City:BRANCHBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-6021
Mailing Address - Country:US
Mailing Address - Phone:908-203-1199
Mailing Address - Fax:908-203-1448
Practice Address - Street 1:3461 RTE 22
Practice Address - Street 2:SUITE 303
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08876-6021
Practice Address - Country:US
Practice Address - Phone:908-203-1199
Practice Address - Fax:908-203-1448
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI018967001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice