Provider Demographics
NPI:1790853273
Name:BRENT, GEORGE W (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:W
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 1:64 OLD ORCHARD
Mailing Address - Street 2:STE. 508
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077
Mailing Address - Country:US
Mailing Address - Phone:847-675-1045
Mailing Address - Fax:
Practice Address - Street 1:64 OLD ORCHARD
Practice Address - Street 2:STE. 508
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077
Practice Address - Country:US
Practice Address - Phone:847-675-1045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL118781223G0001X
IL1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered1223P0700XDental ProvidersDentistProsthodontics