Individual
BREANNA LEE IRIZARRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1250 E MARSHALL ST, RICHMOND, VA 23298-0566
(804) 828-0602
Mailing address
520 N 12TH ST #238,BOX 980566, RICHMOND, VA 23298-5066
(804) 628-6637
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
0442000445
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/11/2022
Last updated
08/05/2022
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