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General NPI Number Information
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NPI Number | 1104039965
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Entity Type | Organization
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Legal Business Name | VICTORY DENTAL PLLC
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1311 BAY STREET
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City | STATEN ISLAND
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State | NY
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Zip | 10305
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Country | US
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Telephone | 718-447-4510
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Fax | 718-815-0249
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Provider Business Mailing Address
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Address Line | 1759 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10314
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Country | US
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Telephone | 718-447-6400
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Fax | 718-442-4059
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Authorized Official
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Title or Position | OWNER
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Name | MR. STEVEN H BRENMAN
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Credential | DMD
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Telephone | 718-447-6400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 038464
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License Number State | NY
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