Individual
NICOLE BRUBAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
401 MAIN ST, SAVANNA, IL 61074-1535
(815) 273-2212
Mailing address
17-148 EDGEWATER DR, LANARK, IL 61046-9366
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.035468
IL
Other
Enumeration date
05/08/2023
Last updated
08/16/2024
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