Provider Demographics
NPI:1548342850
Name:POSPISIL, BRENT LESLIE (DMD)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:LESLIE
Last Name:POSPISIL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 S VAL VISTA DR STE 106
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-6676
Mailing Address - Country:US
Mailing Address - Phone:480-838-3305
Mailing Address - Fax:480-838-3670
Practice Address - Street 1:2730 S VAL VISTA DR STE 106
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-6676
Practice Address - Country:US
Practice Address - Phone:480-838-3305
Practice Address - Fax:480-838-3670
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ54661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice