Provider Demographics
NPI:1801881149
Name:BRENT, ROB M (DDS)
Entity type:Individual
Prefix:DR
First Name:ROB
Middle Name:M
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 1:2619 VISTA DIABLO CT
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-7033
Mailing Address - Country:US
Mailing Address - Phone:925-462-9540
Mailing Address - Fax:
Practice Address - Street 1:1902 N TRACY BLVD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-2423
Practice Address - Country:US
Practice Address - Phone:209-832-1242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-05-30
Provider Licenses
StateLicense IDTaxonomies
CA314441223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA31444OtherDENTAL LICENSE