Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | G1-0001076 | DE |
NPI | 1003915091 |
---|---|
Provider Name | Dr. Darla Marie Brice |
First Address | Wilmington, DE 19803-3735 |
Second Address | Wilmington, DE 19810-4941 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 08/07/2007 |