MEDICARE: NATHAN L BRENNER DMD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	8285	NC

General Provider Information

NPI Number	:	1013189687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATHAN L BRENNER DMD PA

Provider Business Mailing Address
First Line	:	443 HARRISON AVENUE
Second Line	:
City	:	FRANKLIN
State	:	NC
Zip	:	28734-2580
Country	:	US
Telephone Number	:	828-524-2162
Fax Number	:	828-524-8468

Provider Business Practice Location Address
First Line	:	443 HARRISON AVENUE
Second Line	:
City	:	FRANKLIN
State	:	NC
Zip	:	28734-2580
Country	:	US
Telephone Number	:	828-524-2162
Fax Number	:	828-524-8468

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. NATHAN L BRENNER
Credential	:	DMD
Telephone Number	:	828-524-2162

Provider Enumeration Date	:	03/24/2008
Last Update Date	:	07/07/2011

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