Provider Demographics
NPI:1497840375
Name:BRANT, ROBERT BENJAMIN (DMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:BENJAMIN
Last Name:BRANT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5553 NE GLISAN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-3173
Mailing Address - Country:US
Mailing Address - Phone:503-236-2577
Mailing Address - Fax:503-236-0348
Practice Address - Street 1:5553 NE GLISAN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-3173
Practice Address - Country:US
Practice Address - Phone:503-236-2577
Practice Address - Fax:503-236-0348
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD 66921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice