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General NPI Number Information
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NPI Number | 1992713861
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Entity Type | Organization
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Legal Business Name | C DAVID BRICKMAN DDS MS PC
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 10/10/2016
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Provider Practice Location Address
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Address Line | 144 WEST STREET
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City | EDWARDSVILLE
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State | IL
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Zip | 62025
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Country | US
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Telephone | 618-656-3837
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Fax | 618-656-3520
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Provider Business Mailing Address
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Address Line | 144 WEST ST
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City | EDWARDSVILLE
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State | IL
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Zip | 62025-1468
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Country | US
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Telephone | 618-656-3837
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Fax | 618-656-3520
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. C DAVID BRICKMAN
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Credential | DDS MS
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Telephone | 618-656-3837
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 021001903
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License Number State | IL
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