Provider Demographics
NPI:1821268723
Name:DR. BRIAN BRUMBAUGH
Entity Type:Organization
Organization Name:DR. BRIAN BRUMBAUGH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:BRUMBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-213-2244
Mailing Address - Street 1:42 LAMBERT ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-2421
Mailing Address - Country:US
Mailing Address - Phone:540-213-2244
Mailing Address - Fax:540-213-1957
Practice Address - Street 1:42 LAMBERT ST
Practice Address - Street 2:SUITE 211
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-2421
Practice Address - Country:US
Practice Address - Phone:540-213-2244
Practice Address - Fax:540-213-1957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA0401411636122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9199966Medicaid