Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 2827 | NE |
NPI | 1013403237 |
---|---|
Provider Name | Jason James Brisbin |
First Address | Omaha, NE 68138-6108 |
Second Address | Omaha, NE 68138-6108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2018 |
Last Update Date | 11/07/2018 |