Provider Demographics
NPI:1518188697
Name:BREZAUSEK, LINDA MARIE (DDS)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIE
Last Name:BREZAUSEK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:MARIE
Other - Last Name:SODANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:14932 LIMA RD
Mailing Address - Street 2:
Mailing Address - City:HUNTERTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46748-9275
Mailing Address - Country:US
Mailing Address - Phone:260-637-5848
Mailing Address - Fax:
Practice Address - Street 1:6985 COUNTY ROAD 327
Practice Address - Street 2:
Practice Address - City:GARRETT
Practice Address - State:IN
Practice Address - Zip Code:46738-9765
Practice Address - Country:US
Practice Address - Phone:260-637-8556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120089631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice