Provider Demographics
NPI:1184635781
Name:BRICKMAN, PAUL M (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
Last Name:BRICKMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 EDWIN DR
Mailing Address - Street 2:#103
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-4559
Mailing Address - Country:US
Mailing Address - Phone:757-499-9839
Mailing Address - Fax:757-499-7112
Practice Address - Street 1:351 EDWIN DRIVE
Practice Address - Street 2:#103
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-4559
Practice Address - Country:US
Practice Address - Phone:757-499-9839
Practice Address - Fax:757-499-7112
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA46041223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics