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General NPI Number Information
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NPI Number | 1396884862
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Entity Type | Individual
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Provider Name | RICHARD BRANSON BRINKER D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 07/06/2011
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Provider Practice Location Address
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Address Line | 1435-A SE 8TH TERRACE
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City | CAPE CORAL
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State | FL
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Zip | 33990
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Country | US
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Telephone | 239-574-2000
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Fax | 239-574-1144
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Provider Business Mailing Address
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Address Line | 300 WOODSPATH RD
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City | LIVERPOOL
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State | NY
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Zip | 13090-2840
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Country | US
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Telephone | 315-458-3088
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Fax | 315-458-5682
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN 19314
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License Number State | FL
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