Individual
DR. STEVEN FARREL BRIZENDINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS,MS
Contact information
Practice address
525 S FAIRMONT AVE, SUITE A, LODI, CA 95240-3860
(209) 368-5101
Mailing address
525 S FAIRMONT AVE, SUITE A, LODI, CA 95240-3860
(209) 368-5101
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
30193
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
942168742
TAX ID
CA
Enumeration date
03/28/2007
Last updated
07/08/2007
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