Provider Demographics
NPI:1972633352
Name:BRINSON, LORIE GOODPASTER (DDS)
Entity type:Individual
Prefix:DR
First Name:LORIE
Middle Name:GOODPASTER
Last Name:BRINSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3934 W 96TH ST
Mailing Address - Street 2:STE B
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-2908
Mailing Address - Country:US
Mailing Address - Phone:317-228-0195
Mailing Address - Fax:317-228-0246
Practice Address - Street 1:3934 W 96TH ST
Practice Address - Street 2:STE B
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-2908
Practice Address - Country:US
Practice Address - Phone:317-228-0195
Practice Address - Fax:317-228-0246
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010346A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice