Provider Demographics
NPI:1548768302
Name:VARSHAWSKY, BRENT J (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:J
Last Name:VARSHAWSKY
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 1:1901 WATT AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2152
Mailing Address - Country:US
Mailing Address - Phone:916-483-5677
Mailing Address - Fax:
Practice Address - Street 1:1901 WATT AVE STE 2
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2152
Practice Address - Country:US
Practice Address - Phone:916-483-5677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA349231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice