Provider Demographics
NPI:1245582063
Name:BRENT L FLORINE, DDS, PLLC
Entity Type:Organization
Organization Name:BRENT L FLORINE, DDS, PLLC
Other - Org Name:ORAL SURGERY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:L
Authorized Official - Last Name:FLORINE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-688-8592
Mailing Address - Street 1:4151 KNOB DR STE 101
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1876
Mailing Address - Country:US
Mailing Address - Phone:651-688-8592
Mailing Address - Fax:
Practice Address - Street 1:4151 KNOB DR STE 101
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1876
Practice Address - Country:US
Practice Address - Phone:651-688-8592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9263204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty