Provider Demographics
NPI:1487798815
Name:TRENT, ROBERT BRADLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRADLEY
Last Name:TRENT
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 1:501 TOWER CIR
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-6710
Mailing Address - Country:US
Mailing Address - Phone:405-793-0855
Mailing Address - Fax:405-793-1636
Practice Address - Street 1:501 TOWER CIR
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-6710
Practice Address - Country:US
Practice Address - Phone:405-793-0855
Practice Address - Fax:405-793-1636
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK47121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice