Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 5378 | MD |
NPI | 1083602528 |
---|---|
Provider Name | Warren A Brill |
First Address | Baltimore, MD 21224-3413 |
Second Address | Baltimore, MD 21224-3413 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2005 |
Last Update Date | 08/07/2007 |