Provider Demographics
NPI:1336013242
Name:THE DENTAL STORE, LTD.
Entity type:Organization
Organization Name:THE DENTAL STORE, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:347-415-4944
Mailing Address - Street 1:1061 S ROSELLE RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-3900
Mailing Address - Country:US
Mailing Address - Phone:847-301-0400
Mailing Address - Fax:
Practice Address - Street 1:1455 E GOLF RD STE 118
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1253
Practice Address - Country:US
Practice Address - Phone:847-824-5044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE DENTAL STORE, LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty