Provider Demographics
NPI:1467804583
Name:BRIMLEY, JASON (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:BRIMLEY
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 1:1091 N BLUFF ST STE 812
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-7054
Mailing Address - Country:US
Mailing Address - Phone:435-688-2772
Mailing Address - Fax:
Practice Address - Street 1:1091 N BLUFF ST STE 812
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-7054
Practice Address - Country:US
Practice Address - Phone:435-688-2772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD009512122300000X
UT12888079-8903122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist