Provider Demographics
NPI:1427314921
Name:DENT, BRIAR LEA (MD)
Entity type:Individual
Prefix:
First Name:BRIAR
Middle Name:LEA
Last Name:DENT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRIAR
Other - Middle Name:LEA
Other - Last Name:TERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3030 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577-2574
Mailing Address - Country:US
Mailing Address - Phone:914-848-8880
Mailing Address - Fax:914-848-8881
Practice Address - Street 1:525 E 68TH ST
Practice Address - Street 2:BOX # 207
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065
Practice Address - Country:US
Practice Address - Phone:212-746-5380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT57320208200000X
NY273704208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05106863Medicaid
CT008080420Medicaid