Individual
GARY NEAL BRENNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
97 N MAIN ST, SOUTHAMPTON, NY 11968-3309
(631) 283-6362
Mailing address
97 N MAIN ST, SOUTHAMPTON, NY 11968-3309
(631) 283-6362
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
040360
NY
Other
Enumeration date
09/04/2008
Last updated
09/04/2008
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