Provider Demographics
NPI:1003415183
Name:BRUMELL, ASHLEY (DMD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BRUMELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21268 GREENBROOK DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2044
Mailing Address - Country:US
Mailing Address - Phone:909-455-8318
Mailing Address - Fax:
Practice Address - Street 1:13721 ROSWELL AVE STE C
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-5463
Practice Address - Country:US
Practice Address - Phone:909-627-8544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1057221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice