Provider Demographics
NPI:1457308660
Name:BRUMBAUGH, BRIAN T (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:T
Last Name:BRUMBAUGH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 GOSNELL CROSSING
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401
Mailing Address - Country:US
Mailing Address - Phone:540-213-2244
Mailing Address - Fax:540-213-1957
Practice Address - Street 1:15 GOSNELL CROSSING
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401
Practice Address - Country:US
Practice Address - Phone:540-213-2244
Practice Address - Fax:540-213-1957
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4709008651223P0221X
VA04014116361223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9199966Medicaid
VABB7365489OtherDEA NUMBER
VA9199966Medicaid