Provider Demographics
NPI:1992733661
Name:BRENNER, BETHANEY B (DMD)
Entity type:Individual
Prefix:DR
First Name:BETHANEY
Middle Name:B
Last Name:BRENNER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MILFORD ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06013-1715
Mailing Address - Country:US
Mailing Address - Phone:860-673-7155
Mailing Address - Fax:860-673-9992
Practice Address - Street 1:8 MILFORD ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06013-1715
Practice Address - Country:US
Practice Address - Phone:860-673-7155
Practice Address - Fax:860-673-9992
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT56081223G0001X, 1223X2210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X2210XDental ProvidersDentistOrofacial PainGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT061034821OtherSTATE TAX ID