Individual
BRENDA FLORES SOUSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
6003 BIG TREE RD., LAKEVILLE, NY 14480
(585) 346-3028
(585) 756-5577
Mailing address
6003 BIG TREE RD., LAKEVILLE, NY 14480
(585) 346-3028
(585) 756-5577
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
059051
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1467897009
NPI
NY
Enumeration date
04/23/2015
Last updated
07/21/2022
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