Provider Demographics
NPI:1255502977
Name:BRUMBACH FAMILY DENTISTRY PLLC
Entity Type:Organization
Organization Name:BRUMBACH FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:BRUMBACH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-777-1222
Mailing Address - Street 1:609 N CALGARY CT STE 104
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-8165
Mailing Address - Country:US
Mailing Address - Phone:208-777-1222
Mailing Address - Fax:208-777-4555
Practice Address - Street 1:609 N CALGARY CT STE 104
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-8165
Practice Address - Country:US
Practice Address - Phone:208-777-1222
Practice Address - Fax:208-777-4555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD36291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty