Provider Demographics
NPI:1003974825
Name:BRUMMETT, DAVID RUSSELL SR (DMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:RUSSELL
Last Name:BRUMMETT
Suffix:SR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3876 SOUTH HWY 27
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501
Mailing Address - Country:US
Mailing Address - Phone:606-679-5328
Mailing Address - Fax:606-679-1972
Practice Address - Street 1:3876 SOUTH HWY 27
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501
Practice Address - Country:US
Practice Address - Phone:606-679-5328
Practice Address - Fax:606-679-1972
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4698122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY45004264Medicaid
KY60046984Medicaid