Provider Demographics
NPI:1548350952
Name:HERBERT BRICKEN DDS PA
Entity type:Organization
Organization Name:HERBERT BRICKEN DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BRICKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-879-0280
Mailing Address - Street 1:2415 MUSGROVE ROAD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904
Mailing Address - Country:US
Mailing Address - Phone:301-879-0280
Mailing Address - Fax:
Practice Address - Street 1:2415 MUSGROVE ROAD
Practice Address - Street 2:SUITE 109
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904
Practice Address - Country:US
Practice Address - Phone:301-879-0280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25921223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty