Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | RES1324 | OK |
N | 208200000X | Surgeon | RES1324 | OK |
N | 208600000X | Surgeon | RES1324 | OK |
NPI | 1083066021 |
---|---|
Provider Name | Dr. Brandon Soelberg |
First Address | Oklahoma City, OK 73120-6000 |
Second Address | Encinitas, CA 92024-2400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2016 |
Last Update Date | 28/05/2020 |