Provider Demographics
NPI:1760557086
Name:BRINCKHAUS, LILY ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:LILY
Middle Name:ELIZABETH
Last Name:BRINCKHAUS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LILY
Other - Middle Name:ELIZABETH
Other - Last Name:BRINKHAUS FLORIDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:390 W CLAY ST SUITE 2
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482
Mailing Address - Country:US
Mailing Address - Phone:707-462-2170
Mailing Address - Fax:707-462-1195
Practice Address - Street 1:390 W CLAY ST SUITE 2
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482
Practice Address - Country:US
Practice Address - Phone:707-462-2170
Practice Address - Fax:707-462-1195
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39927122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist