Provider Demographics
NPI:1740228626
Name:SEARS, BRENT D (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:D
Last Name:SEARS
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 1:10365 HOOD RD S
Mailing Address - Street 2:SUITE 102
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-3259
Mailing Address - Country:US
Mailing Address - Phone:904-262-7770
Mailing Address - Fax:904-262-7767
Practice Address - Street 1:10365 HOOD RD S
Practice Address - Street 2:SUITE 102
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-3259
Practice Address - Country:US
Practice Address - Phone:904-262-7770
Practice Address - Fax:904-262-7767
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN157781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075848500Medicaid