Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 30021126 | OH |
NPI | 1073604930 |
---|---|
Provider Name | Dr. Andrea Renee Leopold Brinkman |
First Address | Lima, OH 45806 |
Second Address | Lima, OH 45806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2354429 | (05) | OH |