Brenner Dental Group

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

D11525 Issued in MN

Legal business name

BRENNER DENTAL GROUP

Practice address

106 W Broadway St
Monticello, MN 55362-9351

Phone

(763) 295-2905

NPI assigned

Mar 3, 2014

Last updated

Mar 3, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Corey J Brenner, DDS

Title

Owner

Phone

(612) 819-1223

Specialties & licenses 1

Addresses

Tax ID family

Brenner Dental Group2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Brenner Dental Group

  • Dental Clinic/Center
  • Buffalo, MN
  • NPI 1699190488
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1393804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1393804800000",
    "number": "1508281395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 W BROADWAY ST",
            "city": "MONTICELLO",
            "state": "MN",
            "postal_code": "553629351",
            "telephone_number": "763-295-2905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 W BROADWAY ST",
            "city": "MONTICELLO",
            "state": "MN",
            "postal_code": "553629351",
            "telephone_number": "763-295-2905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRENNER DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-03",
        "last_updated": "2014-03-03",
        "status": "A",
        "authorized_official_last_name": "BRENNER",
        "authorized_official_first_name": "COREY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-819-1223",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MN",
            "license": "D11525",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Borgstrom, CNM
• Joanna Borrell
• Rachel Brandt, PHARMD
• Danielle Sarah Brant, BES, BS, LADC, LICSW
• Shannon Breitkreutz, L.P.
• Angela M. Brown, OTR/L
• Anna Bruggeman
• Shaylei Mae Brutger, MS, RD, LD
• Michael Buchman, PT, DPT
• Buffalo Dental Center

• Dental Clinic/Center in Monticello, MN
• Providers in Monticello, MN by specialty
• Dental Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.