Basic Information
Provider Information
NPI: 1932356391
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BRENER
FirstName: SANDRA
MiddleName: R
NamePrefix: DR.
NameSuffix:  
Credential: D.D.S
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11165 WHITEHAWK ST
Address2:  
City: PLANTATION
State: FL
PostalCode: 333242175
CountryCode: US
TelephoneNumber: 9543948996
FaxNumber:  
Practice Location
Address1: 9720 STIRLING RD
Address2: SUITE 100
City: HOLLYWOOD
State: FL
PostalCode: 330248013
CountryCode: US
TelephoneNumber: 9542627500
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/27/2008
LastUpdateDate: 03/03/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223P0221XDN18599FLY Dental ProvidersDentistPediatric Dentistry

No ID Information.


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