Provider Demographics
NPI:1194862789
Name:BRIMHALL, LANCE C I (DDS)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:C
Last Name:BRIMHALL
Suffix:I
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:LANCE
Other - Middle Name:C
Other - Last Name:BRIMHALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:121 4TH STREET NORTH STE. 2D
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-2552
Mailing Address - Country:US
Mailing Address - Phone:406-453-6467
Mailing Address - Fax:
Practice Address - Street 1:121 4TH ST N STE 2D
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-2552
Practice Address - Country:US
Practice Address - Phone:406-453-6467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT18161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice