Provider Demographics
NPI:1265568208
Name:BRICENO, HECTOR L (DMD)
Entity type:Individual
Prefix:DR
First Name:HECTOR
Middle Name:L
Last Name:BRICENO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12200 W COLONIAL DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4125
Mailing Address - Country:US
Mailing Address - Phone:407-656-9455
Mailing Address - Fax:407-656-6145
Practice Address - Street 1:12200 W COLONIAL DR
Practice Address - Street 2:SUITE 103
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4125
Practice Address - Country:US
Practice Address - Phone:407-656-9455
Practice Address - Fax:407-656-6145
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN155391223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery