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General NPI Number Information
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NPI Number | 1336013242
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Entity Type | Organization
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Legal Business Name | THE DENTAL STORE, LTD.
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Dates
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Enumeration Date | 10/02/2025
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 1455 E GOLF RD STE 118
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City | DES PLAINES
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State | IL
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Zip | 60016-1253
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Country | US
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Telephone | 847-824-5044
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Fax |
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Provider Business Mailing Address
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Address Line | 1061 S ROSELLE RD
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City | SCHAUMBURG
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State | IL
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Zip | 60193-3900
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Country | US
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Telephone | 847-301-0400
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JASON BRENNER
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Credential | DDS
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Telephone | 347-415-4944
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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 |
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License Number State |
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