Provider Demographics
NPI:1992319107
Name:BRENNER, JORDAN L (DDS)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:L
Last Name:BRENNER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1169 HILLTOP PKWY UNIT 203
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-2523
Mailing Address - Country:US
Mailing Address - Phone:970-871-0033
Mailing Address - Fax:970-871-0034
Practice Address - Street 1:1169 HILLTOP PKWY UNIT 203
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-2523
Practice Address - Country:US
Practice Address - Phone:970-871-0033
Practice Address - Fax:970-871-0034
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY15561223G0001X
CO2050931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice