Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 12792 | TX |
NPI | 1700997830 |
---|---|
Provider Name | Brenda Lee Bellocchio |
First Address | Austin, TX 78704-5466 |
Second Address | Austin, TX 78704-5466 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |