Provider Demographics
NPI:1942655055
Name:PUCAN, BRISBAIN RIGOR (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRISBAIN
Middle Name:RIGOR
Last Name:PUCAN
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 1:2143 SPRINGS RD, #51
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591
Mailing Address - Country:US
Mailing Address - Phone:707-552-3952
Mailing Address - Fax:707-552-9320
Practice Address - Street 1:2143 SPRINGS RD,
Practice Address - Street 2:#51
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591
Practice Address - Country:US
Practice Address - Phone:707-552-3952
Practice Address - Fax:707-552-9320
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40709122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist