Provider Demographics
NPI:1588793392
Name:DENT, BRIAN T (DC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:T
Last Name:DENT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6307 HAZELWEST CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-1739
Mailing Address - Country:US
Mailing Address - Phone:314-895-3328
Mailing Address - Fax:314-731-4832
Practice Address - Street 1:6307 HAZELWEST CT
Practice Address - Street 2:SUITE 100
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1739
Practice Address - Country:US
Practice Address - Phone:314-895-3328
Practice Address - Fax:314-731-4832
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005912111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU06147Medicare UPIN