Provider Demographics
NPI:1861881120
Name:ERICKA T MCBRINE DDS PA
Entity type:Organization
Organization Name:ERICKA T MCBRINE DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICKA
Authorized Official - Middle Name:T
Authorized Official - Last Name:MCBRINE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:830-990-1178
Mailing Address - Street 1:101 W CREEK ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-3730
Mailing Address - Country:US
Mailing Address - Phone:830-990-1178
Mailing Address - Fax:830-990-2338
Practice Address - Street 1:101 W CREEK ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-3730
Practice Address - Country:US
Practice Address - Phone:830-990-1178
Practice Address - Fax:830-990-2338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22785122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty