Provider Demographics
NPI:1508024746
Name:AGRAN, BRENT EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:EDWARD
Last Name:AGRAN
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 1:5820 N CLARK ST STE 1S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-3213
Mailing Address - Country:US
Mailing Address - Phone:773-561-2237
Mailing Address - Fax:773-878-5467
Practice Address - Street 1:5820 N CLARK ST STE 1S
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660
Practice Address - Country:US
Practice Address - Phone:773-561-2237
Practice Address - Fax:773-878-5467
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027610122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist