Provider Demographics
NPI:1639666415
Name:DANLEY, BRENT
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:DANLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 W US HIGHWAY 82
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:TX
Mailing Address - Zip Code:75570-2804
Mailing Address - Country:US
Mailing Address - Phone:903-628-5437
Mailing Address - Fax:
Practice Address - Street 1:112 W US HIGHWAY 82
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:TX
Practice Address - Zip Code:75570-2804
Practice Address - Country:US
Practice Address - Phone:903-628-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR44171223P0221X
TX361471223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry