Provider Demographics
NPI:1134328016
Name:DOBSON, BRENT SHANNON (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:SHANNON
Last Name:DOBSON
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:12813 E 101ST PL N
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4662
Mailing Address - Country:US
Mailing Address - Phone:918-272-4242
Mailing Address - Fax:918-272-5753
Practice Address - Street 1:12813 E 101ST PL N
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4662
Practice Address - Country:US
Practice Address - Phone:918-272-4242
Practice Address - Fax:918-272-5753
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK54771223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics