Provider Demographics
NPI:1942237284
Name:DUPPER, BRENT DOUGLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:DOUGLAS
Last Name:DUPPER
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 1:1310 RANCH ROAD 620 S STE B6
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-6346
Mailing Address - Country:US
Mailing Address - Phone:512-263-0064
Mailing Address - Fax:909-558-6469
Practice Address - Street 1:1310 RANCH ROAD 620 S STE B6
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-6346
Practice Address - Country:US
Practice Address - Phone:512-263-0064
Practice Address - Fax:909-558-6469
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA360771223G0001X
TX33633122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice