Provider Demographics
NPI:1407300213
Name:BRIMHALL, REBECCA (RDH)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BRIMHALL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10817 PENNYBACK PARK DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-4891
Mailing Address - Country:US
Mailing Address - Phone:928-266-5476
Mailing Address - Fax:
Practice Address - Street 1:4400 CUTLER AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3935
Practice Address - Country:US
Practice Address - Phone:855-384-7462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4260124Q00000X
AZ7124124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist