MEDICARE: DR. BRIGID WALSH TRENT DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	55345	CA
2	1223G0001X	General Practice Dentistry	019.027082	IL

General Provider Information

NPI Number	:	1417126913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIGID WALSH TRENT DDS

Provider Business Mailing Address
First Line	:	2201 BALFOUR RD STE A
Second Line	:
City	:	BRENTWOOD
State	:	CA
Zip	:	94513-4927
Country	:	US
Telephone Number	:	925-308-7608
Fax Number	:	925-308-7542

Provider Business Practice Location Address
First Line	:	2201 BALFOUR RD STE A
Second Line	:
City	:	BRENTWOOD
State	:	CA
Zip	:	94513-4927
Country	:	US
Telephone Number	:	925-308-7608
Fax Number	:	925-308-7542

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2008
Last Update Date	:	03/10/2023

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