Healthcare Provider Details

I. General information

NPI: 1851325757
Provider Name (Legal Business Name): RENRICK BENN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 METROTECH CENTER LOBBY
BROOKLYN NY
11201
US

IV. Provider business mailing address

4 METROTECH CENTER LOBBY
BROOKLYN NY
11201
US

V. Phone/Fax

Practice location:
  • Phone: 718-403-0700
  • Fax: 718-403-0441
Mailing address:
  • Phone: 718-403-0700
  • Fax: 718-403-0441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number40700
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: