Provider Demographics
NPI:1598852568
Name:HANLIN, BRENT T (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:T
Last Name:HANLIN
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 1:75 KENNELWORTH CIR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:IL
Mailing Address - Zip Code:61256-9663
Mailing Address - Country:US
Mailing Address - Phone:309-755-5917
Mailing Address - Fax:
Practice Address - Street 1:310 46TH AVE
Practice Address - Street 2:
Practice Address - City:EAST MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61244-4282
Practice Address - Country:US
Practice Address - Phone:309-792-2815
Practice Address - Fax:309-792-2915
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice