Healthcare Provider Details

I. General information

NPI: 1497840375
Provider Name (Legal Business Name): ROBERT BENJAMIN BRANT DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 11/12/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 4TH AVE N STE 1
BILLINGS MT
59101-1312
US

IV. Provider business mailing address

2525 4TH AVE N STE 1
BILLINGS MT
59101-1312
US

V. Phone/Fax

Practice location:
  • Phone: 406-256-2121
  • Fax: 406-545-3320
Mailing address:
  • Phone: 406-256-2121
  • Fax: 406-545-3320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number21627
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number21267
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number21627
License Number StateMT
# 4
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD6692
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: