Jordan M Brenner, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

DE60291757 Issued in WA

Practice address

1359 N 205TH St
Shoreline, WA 98133-3215

Phone

(206) 533-9693

Fax

(206) 533-9691

NPI assigned

Jul 30, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jordan Brenner DDS, PLLC

  • General Practice Dentistry
  • Shoreline, WA
  • NPI 1609289073
  NPD (past) Authorized official

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

{
    "created_epoch": "1343606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701129600000",
    "number": "1902152887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1359 N 205TH ST",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "981333215",
            "telephone_number": "206-533-9693",
            "fax_number": "206-533-9691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1359 N 205TH ST",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "981333215",
            "telephone_number": "206-533-9693",
            "fax_number": "206-533-9691"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "715 Bluegrass Cir",
            "address_purpose": "LOCATION",
            "city": "Cedar Falls",
            "state": "IA",
            "postal_code": "506137978",
            "country_code": "US",
            "telephone_number": "319-266-3545",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRENNER",
        "first_name": "JORDAN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-30",
        "last_updated": "2023-11-28",
        "certification_date": "2023-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IA",
            "license": "DDS-09972",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE60291757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Bowman, DVM
• Patricia Misa Bowman, LMP
• Zahara Ellanya Boyd
• Jesse J Boyett, DDS, PLLC
• Matthew Kegan Branaman, L.M.P
• Nicole Bride
• Katherine Brittain
• Birgit Jennifer Broadstone, PT
• Kate Brockhaus, LMHCA
• Emily Brothers, RN

• Dentist in Shoreline, WA
• Providers in Shoreline, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2023; 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.