Healthcare Provider Details

I. General information

NPI: 1528097078
Provider Name (Legal Business Name): RENE A BRIGNONI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 NW 76TH DR
GAINESVILLE FL
32607-6652
US

IV. Provider business mailing address

3907 SW 86TH ST
GAINESVILLE FL
32608-7901
US

V. Phone/Fax

Practice location:
  • Phone: 352-332-3939
  • Fax: 352-332-2592
Mailing address:
  • Phone: 352-379-4040
  • Fax: 352-379-7450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberD14998
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: