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General NPI Number Information
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NPI Number | 1588547434
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Entity Type | Individual
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Provider Name | BRADLEY RENNER DDS
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Gender | Male
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Dates
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Enumeration Date | 07/29/2025
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 4995 S COUNTY TRL
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City | CHARLESTOWN
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State | RI
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Zip | 02813-3182
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Country | US
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Telephone | 401-364-6300
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Fax |
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Provider Business Mailing Address
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Address Line | 5 CAROLINA NOOSENECK ROAD UNIT 5A
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City | RICHMOND
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State | RI
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Zip | 02898
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Country | US
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Telephone | 813-476-0763
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DEN03805
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License Number State | RI
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