Provider Demographics
NPI:1043329402
Name:DALE E BRUM, D.D.S. INC.
Entity Type:Organization
Organization Name:DALE E BRUM, D.D.S. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:BRUM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-428-1151
Mailing Address - Street 1:930 AVERY ST
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-4725
Mailing Address - Country:US
Mailing Address - Phone:304-428-1151
Mailing Address - Fax:304-428-0082
Practice Address - Street 1:930 AVERY ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-4725
Practice Address - Country:US
Practice Address - Phone:304-428-1151
Practice Address - Fax:304-428-0082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV26161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000142132OtherPROVIDER ID #