Active NPI
Rob M Brent, DDS
- Periodontics
- Tracy, CA
National Provider Identifier
1801881149
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 31444
- Practice address
- 1902 N Tracy Blvd
Tracy, CA 95376-2423 - Phone
- (209) 832-1242
- NPI assigned
- Sep 13, 2005
- Reactivated
- May 30, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 31444 | CA | Primary |
Addresses
Primary practice location
1902 N Tracy Blvd
Tracy, CA 95376-2423
Mailing address
2619 Vista Diablo CT
Pleasanton, CA 94566-7033
Phone (925) 462-9540
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 31444 | Other | CA | DENTAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1801881149",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2619 VISTA DIABLO CT",
"city": "PLEASANTON",
"state": "CA",
"postal_code": "945667033",
"telephone_number": "925-462-9540"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1902 N TRACY BLVD",
"city": "TRACY",
"state": "CA",
"postal_code": "953762423",
"telephone_number": "209-832-1242"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRENT",
"first_name": "ROB",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-13",
"last_updated": "2007-07-08",
"deactivation_date": "2006-03-25",
"reactivation_date": "2006-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "31444",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL LICENSE",
"identifier": "31444",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tracy, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.