MEDICARE: BRANDI NOORDMANS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	58841	CA

General Provider Information

NPI Number	:	1700111093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDI NOORDMANS DDS

Provider Business Mailing Address
First Line	:	1620 S PADRE ISLAND DR
Second Line	:	#600
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78416-1353
Country	:	US
Telephone Number	:	831-295-0824
Fax Number	:

Provider Business Practice Location Address
First Line	:	1620 S PADRE ISLAND DR
Second Line	:	#600
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78416-1353
Country	:	US
Telephone Number	:	831-295-0824
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2009
Last Update Date	:	01/27/2014

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