Provider Demographics
NPI:1780901090
Name:LIEFFRING, BROOKE ANGELA (RDH)
Entity type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:ANGELA
Last Name:LIEFFRING
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W5281 STATE HIGHWAY 85
Mailing Address - Street 2:
Mailing Address - City:DURAND
Mailing Address - State:WI
Mailing Address - Zip Code:54736-4833
Mailing Address - Country:US
Mailing Address - Phone:715-672-4026
Mailing Address - Fax:
Practice Address - Street 1:1018 REGIS CT
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4404
Practice Address - Country:US
Practice Address - Phone:715-832-8063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6657124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist