Provider Demographics
NPI:1558598961
Name:RISING, BRENT JAMISON (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:JAMISON
Last Name:RISING
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 1:4417 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-1758
Mailing Address - Country:US
Mailing Address - Phone:701-799-6453
Mailing Address - Fax:
Practice Address - Street 1:14406 HARRISON ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68138-6521
Practice Address - Country:US
Practice Address - Phone:402-333-1120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE68121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice