Healthcare Provider Details

I. General information

NPI: 1407003650
Provider Name (Legal Business Name): BRENT H BETHERS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20755 W MCDOWELL RD STE 111
BUCKEYE AZ
85396-2072
US

IV. Provider business mailing address

20755 W MCDOWELL RD STE 111
BUCKEYE AZ
85396-2072
US

V. Phone/Fax

Practice location:
  • Phone: 623-439-2222
  • Fax: 623-439-2224
Mailing address:
  • Phone: 623-439-2222
  • Fax: 623-439-2224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD010233
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: