Provider Demographics
NPI:1649237686
Name:BRUMBACH, ZACHARY HARRIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:HARRIS
Last Name:BRUMBACH
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 1:609 N CALGARY CT STE 104
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-4906
Mailing Address - Country:US
Mailing Address - Phone:208-777-1222
Mailing Address - Fax:
Practice Address - Street 1:609 CALGARY CT. SUITE 104
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854
Practice Address - Country:US
Practice Address - Phone:208-777-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD-8344122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5043971OtherOREGON HEALTH PLAN