Provider Demographics
NPI:1124291919
Name:BRINDIS, TARA GILPIN (DDS)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:GILPIN
Last Name:BRINDIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:A
Other - Last Name:GILPIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:4228 HOUMA BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-3005
Mailing Address - Country:US
Mailing Address - Phone:504-883-3737
Mailing Address - Fax:
Practice Address - Street 1:4228 HOUMA BLVD STE 210
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-3005
Practice Address - Country:US
Practice Address - Phone:504-883-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA59671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1893153Medicaid