MEDICARE: ROBERT E BRICKER, DDS, LTD

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	1223G0001X	General Practice Dentistry	1443	WV

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	:	1619096930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT E BRICKER, DDS, LTD

Provider Business Mailing Address
First Line	:	514 C ST
Second Line	:
City	:	SAINT ALBANS
State	:	WV
Zip	:	25177-2720
Country	:	US
Telephone Number	:	304-727-2294
Fax Number	:	304-727-4928

Provider Business Practice Location Address
First Line	:	512 C ST
Second Line	:
City	:	SAINT ALBANS
State	:	WV
Zip	:	25177-2720
Country	:	US
Telephone Number	:	304-727-2294
Fax Number	:	304-727-4928

Authorized Official
Title or Position	:	DENTIST
Name	:	ROBERT E BRICKER
Credential	:	DDS
Telephone Number	:	304-727-2294

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	09/20/2007

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