Provider Demographics
NPI:1942994124
Name:HAWS, BRENT DANIEL (DMD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:DANIEL
Last Name:HAWS
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 1:750 E 3RD ST APT A11
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-2047
Mailing Address - Country:US
Mailing Address - Phone:520-508-1377
Mailing Address - Fax:
Practice Address - Street 1:750 E 3RD ST APT A11
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-2047
Practice Address - Country:US
Practice Address - Phone:520-508-1377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program