Provider Demographics
NPI:1053687111
Name:ORT, BRENT C (DDS)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:C
Last Name:ORT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 POST ST STE 412
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-1405
Mailing Address - Country:US
Mailing Address - Phone:415-956-6667
Mailing Address - Fax:
Practice Address - Street 1:490 POST ST STE 412
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-1405
Practice Address - Country:US
Practice Address - Phone:415-956-6667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34808122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist