Provider Demographics
NPI:1760124754
Name:BRIZARD, LOURDES C (DMD)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:C
Last Name:BRIZARD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17609 SW 140TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-7756
Mailing Address - Country:US
Mailing Address - Phone:786-314-3863
Mailing Address - Fax:
Practice Address - Street 1:4410 W 16TH AVE STE 52
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7193
Practice Address - Country:US
Practice Address - Phone:305-825-9899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN27599122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program