Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 54035 | CA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | A118083 | CA |
NPI | 1265561641 |
---|---|
Provider Name | Dr. David Trent |
First Address | San Francisco, CA 94143-2205 |
Second Address | San Francisco, CA 94143-2205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2007 |
Last Update Date | 06/06/2016 |