Healthcare Provider Details

I. General information

NPI: 1265620942
Provider Name (Legal Business Name): MARCO ANTONIO BRINDIS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/05/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4228 HOUMA BLVD STE 210
METAIRIE LA
70006-3005
US

IV. Provider business mailing address

4228 HOUMA BLVD STE 210
METAIRIE LA
70006-3005
US

V. Phone/Fax

Practice location:
  • Phone: 504-883-3737
  • Fax:
Mailing address:
  • Phone: 504-883-3737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number7105
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: