MEDICARE: LORIE G BRINSON, DDS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223D0001X	Public Health Dentistry	12010346A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205353802
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LORIE G BRINSON, DDS, PC

Provider Business Mailing Address
First Line	:	3934 W 96TH ST STE B
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-2928
Country	:	US
Telephone Number	:	317-228-0195
Fax Number	:	317-228-0246

Provider Business Practice Location Address
First Line	:	3934 W 96TH ST STE B
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-2928
Country	:	US
Telephone Number	:	317-228-0195
Fax Number	:	317-228-0246

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LORIE GOODPASTER BRINSON
Credential	:	DDS
Telephone Number	:	317-228-0195

Provider Enumeration Date	:	08/24/2017
Last Update Date	:	07/21/2022

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