Provider Demographics
NPI:1619974847
Name:BRENT, PAUL D (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:D
Last Name:BRENT
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 1:18395 SW ALEXANDER ST
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97006-3961
Mailing Address - Country:US
Mailing Address - Phone:503-642-4552
Mailing Address - Fax:503-591-0202
Practice Address - Street 1:18395 SW ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97006-3961
Practice Address - Country:US
Practice Address - Phone:503-642-4552
Practice Address - Fax:503-591-0202
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR74951223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics