Healthcare Provider Details

I. General information

NPI: 1982954210
Provider Name (Legal Business Name): BRENT ARTHUR TALBOT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 03/20/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

634 B ST
JBER AK
99505-6650
US

IV. Provider business mailing address

RICHARDSON DENTAL CLINIC 634 B STREET
JBER AK
99505
US

V. Phone/Fax

Practice location:
  • Phone: 907-384-2483
  • Fax:
Mailing address:
  • Phone: 907-384-2483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number8344088-9921
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8344088-9921
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: