Brenner Dental Group

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

D11525 Issued in MN

Legal business name

BRENNER DENTAL GROUP

Practice address

102 Marty Dr
Suite 3
Buffalo, MN 55313-9305

Phone

(763) 682-2101

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

Other names 1

• Buffalo Dental Clinic Former legal business name

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
  • Monticello, MN
  • NPI 1508281395
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nicole Leigh Tripp, D.D.S.

  • General Practice Dentistry
  • Maple Lake, MN
  • NPI 1205273042
  NPD (past)

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": "1699190488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 MARTY DR",
            "address_2": "SUITE 3",
            "city": "BUFFALO",
            "state": "MN",
            "postal_code": "553139305",
            "telephone_number": "763-682-2101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 MARTY DR",
            "address_2": "SUITE 3",
            "city": "BUFFALO",
            "state": "MN",
            "postal_code": "553139305",
            "telephone_number": "763-682-2101"
        }
    ],
    "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": [
        {
            "organization_name": "Buffalo Dental Clinic",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Kayla Lee Ellen Louise Bickford
• Bio-Medical Applications of Minnesota, Inc. (Buffalo Dialysis Center)
• Tamra L Blahut, PT
• Cleo Sharon Boll, MA, LMFT
• Bianca Bonniwell, OTR/L
• Bridging Hope Counseling Services LLC
• Tatum Natalie Britton, FNP- C
• Gerald Paul Brost, D.C.
• Barbara Joan Brower, R.D., L.D.
• Ronald Duane Brown, MD

• Dental Clinic/Center in Buffalo, MN
• Providers in Buffalo, 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.