Provider Demographics
NPI:1083821680
Name:BRUMBAUGH, DENNIS RICHARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:RICHARD
Last Name:BRUMBAUGH
Suffix:
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 1:1177 SOUTH 6TH ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701
Mailing Address - Country:US
Mailing Address - Phone:724-465-2036
Mailing Address - Fax:724-465-2037
Practice Address - Street 1:1177 SOUTH 6TH ST
Practice Address - Street 2:SUITE G
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701
Practice Address - Country:US
Practice Address - Phone:724-465-2036
Practice Address - Fax:724-465-2037
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 021711L122300000X
PAPA-DS021711L122300000X
PADP000596122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist