Provider Demographics
NPI:1306991039
Name:BRAWLEY, BRENT ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:ALAN
Last Name:BRAWLEY
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 1:1926 STALLION CIR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-6564
Mailing Address - Country:US
Mailing Address - Phone:972-475-5000
Mailing Address - Fax:972-272-3589
Practice Address - Street 1:1213 W STATE ST STE A
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-6153
Practice Address - Country:US
Practice Address - Phone:972-272-3585
Practice Address - Fax:972-272-3589
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX125441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice