Provider Demographics
NPI:1992969513
Name:RICHARD J. BRENNER, D.D.S., LTD.
Entity type:Organization
Organization Name:RICHARD J. BRENNER, D.D.S., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-323-0409
Mailing Address - Street 1:211 W CHICAGO AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3355
Mailing Address - Country:US
Mailing Address - Phone:630-323-0409
Mailing Address - Fax:
Practice Address - Street 1:211 W CHICAGO AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3355
Practice Address - Country:US
Practice Address - Phone:630-323-0409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-13
Last Update Date:2008-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0204541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty