Provider Demographics
NPI:1982954210
Name:TALBOT, BRENT ARTHUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:ARTHUR
Last Name:TALBOT
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:RICHARDSON DENTAL CLINIC
Mailing Address - Street 2:634 B STREET
Mailing Address - City:JBER
Mailing Address - State:AK
Mailing Address - Zip Code:99505
Mailing Address - Country:US
Mailing Address - Phone:907-384-2483
Mailing Address - Fax:
Practice Address - Street 1:634 B ST
Practice Address - Street 2:
Practice Address - City:JBER
Practice Address - State:AK
Practice Address - Zip Code:99505-6650
Practice Address - Country:US
Practice Address - Phone:907-384-2483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8344088-99211223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist