Individual
DR. BRENT EUGENE SHAKESPEARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1454 E 2ND ST, SAN BERNARDINO, CA 92408-0118
(909) 382-7146
(909) 382-7101
Mailing address
1454 E 2ND ST, SAN BERNARDINO, CA 92408-0118
(909) 382-7146
(909) 382-7101
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
36872
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36872
STATE LICENSE NUMBER
CA
Enumeration date
04/26/2007
Last updated
04/15/2013
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