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General NPI Number Information
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NPI Number | 1255547527
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Entity Type | Organization
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Legal Business Name | JACK H. BRENNER, DDS
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6280 SUNSET DRIVE SUITE 401
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City | SOUTH MIAMI
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State | FL
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Zip | 33143
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Country | US
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Telephone | 305-661-5360
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Fax |
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Provider Business Mailing Address
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Address Line | 10510 SW 99 STREET
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City | MIAMI
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State | FL
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Zip | 33176
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Country | US
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Telephone | 305-274-3530
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACK H BRENNER
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Credential | DDS
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Telephone | 305-661-5360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3296
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License Number State | FL
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