Provider Demographics
NPI:1568072668
Name:BRIMFIELD FAMILY DENTISTRY, P.C.
Entity Type:Organization
Organization Name:BRIMFIELD FAMILY DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:309-396-3123
Mailing Address - Street 1:232 E KNOXVILLE ST
Mailing Address - Street 2:
Mailing Address - City:BRIMFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:61517-8103
Mailing Address - Country:US
Mailing Address - Phone:309-396-3123
Mailing Address - Fax:
Practice Address - Street 1:232 E KNOXVILLE ST
Practice Address - Street 2:
Practice Address - City:BRIMFIELD
Practice Address - State:IL
Practice Address - Zip Code:61517-8103
Practice Address - Country:US
Practice Address - Phone:309-320-8750
Practice Address - Fax:309-233-2023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-04
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental