Provider Demographics
NPI:1053581033
Name:BROTT, NATHAN CHARLES (DDS)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:CHARLES
Last Name:BROTT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SIERRA COLLEGE DRIVE
Mailing Address - Street 2:SUITE 285
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945
Mailing Address - Country:US
Mailing Address - Phone:530-272-9400
Mailing Address - Fax:530-272-9404
Practice Address - Street 1:300 SIERRA COLLEGE DRIVE
Practice Address - Street 2:SUITE 285
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945
Practice Address - Country:US
Practice Address - Phone:530-272-9400
Practice Address - Fax:530-272-9404
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42978122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist