Provider Demographics
NPI:1457447278
Name:PARROTT, BRENT ELLIS (DDS)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:ELLIS
Last Name:PARROTT
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 1:22450 S 201ST CT
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-6311
Mailing Address - Country:US
Mailing Address - Phone:530-966-5335
Mailing Address - Fax:
Practice Address - Street 1:2014 5TH AVE
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-5815
Practice Address - Country:US
Practice Address - Phone:530-533-8204
Practice Address - Fax:530-533-3161
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ46661223G0001X
CAC469211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
1457447278OtherNPI
1467179325OtherNPI
AZ86-0939087OtherFEDERAL BUSINESS ID
AZ07-549561-VOtherSTATE BUSINESS ID
1942687215OtherNPI