Individual provider Active NPI

Robert Bradley Trent, D.D.S.

  • General Practice Dentistry
  • Moore, OK
National Provider Identifier
1487798815
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4712 Issued in OK
Practice address
501 Tower Cir
Moore, OK 73160-6710
Phone
(405) 793-0855
Fax
(405) 793-1636
NPI assigned
Feb 18, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 4712 OK Primary

Addresses

Primary practice location

501 Tower Cir
Moore, OK 73160-6710

Mailing address

501 Tower Cir
Moore, OK 73160-6710
Phone (405) 793-0855

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160322000226 OK Order and Referring Only - DentistPractitioner - Dentist 6406153378

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1487798815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 TOWER CIR",
            "city": "MOORE",
            "state": "OK",
            "postal_code": "731606710",
            "telephone_number": "405-793-0855",
            "fax_number": "405-793-1636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 TOWER CIR",
            "city": "MOORE",
            "state": "OK",
            "postal_code": "731606710",
            "telephone_number": "405-793-0855",
            "fax_number": "405-793-1636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRENT",
        "first_name": "ROBERT",
        "middle_name": "BRADLEY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "4712",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moore, OK

Sources for this page

Verify at the official NPI Registry.