Provider Demographics
NPI:1932245453
Name:PUTMAN, J BRIAN (DDS)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:BRIAN
Last Name:PUTMAN
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 1:1223 GRANT AVE
Mailing Address - Street 2:#A
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945
Mailing Address - Country:US
Mailing Address - Phone:415-892-6969
Mailing Address - Fax:
Practice Address - Street 1:1223 GRANT AVE
Practice Address - Street 2:#A
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945
Practice Address - Country:US
Practice Address - Phone:415-892-6969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24329122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist