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General NPI Number Information
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NPI Number | 1619096930
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Entity Type | Organization
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Legal Business Name | ROBERT E BRICKER, DDS, LTD
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 09/20/2007
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Provider Practice Location Address
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Address Line | 512 C ST
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City | SAINT ALBANS
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State | WV
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Zip | 25177-2720
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Country | US
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Telephone | 304-727-2294
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Fax | 304-727-4928
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Provider Business Mailing Address
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Address Line | 514 C ST
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City | SAINT ALBANS
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State | WV
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Zip | 25177-2720
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Country | US
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Telephone | 304-727-2294
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Fax | 304-727-4928
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Authorized Official
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Title or Position | DENTIST
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Name | ROBERT E BRICKER
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Credential | DDS
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Telephone | 304-727-2294
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 1443
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License Number State | WV
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