Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | HAD48 | FL |
N | 1223G0001X | General Practice | 019.027082 | IL |
N | 213EG0000X | General Practice | 019.027082 | IL |
N | 1223P0221X | Pediatric Dentist | 55345 | CA |
NPI | 1417126913 |
---|---|
Provider Name | Dr. Brigid Walsh Trent |
First Address | Winter Garden, FL 34787-3546 |
Second Address | Orlando, FL 32824-9482 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2008 |
Last Update Date | 20/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
005537700 | (05) | FL |