Provider Demographics
NPI:1396884862
Name:BRINKER, RICHARD BRANSON (DMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BRANSON
Last Name:BRINKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 WOODSPATH RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-2840
Mailing Address - Country:US
Mailing Address - Phone:315-458-3088
Mailing Address - Fax:315-458-5682
Practice Address - Street 1:1435-A SE 8TH TERRACE
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990
Practice Address - Country:US
Practice Address - Phone:239-574-2000
Practice Address - Fax:239-574-1144
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 193141223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery