Provider Demographics
NPI:1265440333
Name:FLORINE, BRENT LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:LEE
Last Name:FLORINE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:4151 KNOB DR STE 101
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1876
Mailing Address - Country:US
Mailing Address - Phone:651-688-8592
Mailing Address - Fax:651-688-3415
Practice Address - Street 1:4151 KNOB DR STE 101
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1876
Practice Address - Country:US
Practice Address - Phone:651-688-8592
Practice Address - Fax:651-688-3415
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN92631223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery