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General NPI Number Information
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NPI Number | 1760124754
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Entity Type | Individual
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Provider Name | LOURDES C BRIZARD DMD
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Gender | Female
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Dates
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Enumeration Date | 04/11/2022
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 5200 S WESTNEDGE AVE
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City | PORTAGE
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State | MI
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Zip | 49002-0405
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Country | US
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Telephone | 269-382-6656
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Fax |
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Provider Business Mailing Address
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Address Line | 86 SW 8TH ST UNIT 2407
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City | MIAMI
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State | FL
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Zip | 33130-3795
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Country | US
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Telephone | 786-314-3863
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN27599
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901602028
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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