Provider Demographics
NPI:1396772935
Name:KENT, BRIAN
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:KENT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25277
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66225-5277
Mailing Address - Country:US
Mailing Address - Phone:918-994-4100
Mailing Address - Fax:918-994-4103
Practice Address - Street 1:9206 S TOLEDO AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-2755
Practice Address - Country:US
Practice Address - Phone:918-994-4100
Practice Address - Fax:918-994-4103
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK28104208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200322330AMedicaid
OK200322330AMedicaid