Basic Information
| Provider Information | |||||||||
| NPI: | 1427314921 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DENT | ||||||||
| FirstName: | BRIAR | ||||||||
| MiddleName: | LEA | ||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | TERON | ||||||||
| OtherFirstName: | BRIAR | ||||||||
| OtherMiddleName: | LEA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3030 WESTCHESTER AVE | ||||||||
| Address2: | |||||||||
| City: | PURCHASE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105772574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9148488880 | ||||||||
| FaxNumber: | 9148488881 | ||||||||
| Practice Location | |||||||||
| Address1: | 525 E 68TH ST | ||||||||
| Address2: | BOX # 207 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127465380 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2012 | ||||||||
| LastUpdateDate: | 07/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | 57320 | CT | N | Allopathic & Osteopathic Physicians | Plastic Surgery | 208200000X | 273704 | NY | Y | Allopathic & Osteopathic Physicians | Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 05106863 | 05 | NY | MEDICAID | 008080420 | 05 | CT | MEDICAID |