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General NPI Number Information
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NPI Number | 1619374402
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Entity Type | Individual
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Provider Name | LORRAINE BRENNER D.M.D
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Gender | Female
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Dates
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Enumeration Date | 11/23/2014
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Last Update Date | 09/07/2018
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Provider Practice Location Address
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Address Line | 1053 BLOOMFIELD AVE STE 14
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City | CLIFTON
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State | NJ
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Zip | 07012
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Country | US
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Telephone | 973-471-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 270 MARIN BLVD APT 20K
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City | JERSEY CITY
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State | NJ
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Zip | 07302-3653
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Country | US
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Telephone | 201-247-4992
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 22DI02572400
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License Number State | NJ
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