Provider Demographics
NPI:1871840611
Name:BRIGHAM, JAYMIE (RDHAP)
Entity Type:Individual
Prefix:MS
First Name:JAYMIE
Middle Name:
Last Name:BRIGHAM
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 W SARAH ST
Mailing Address - Street 2:#9
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-3862
Mailing Address - Country:US
Mailing Address - Phone:818-533-1449
Mailing Address - Fax:818-505-9717
Practice Address - Street 1:4300 W SARAH ST
Practice Address - Street 2:#9
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-3862
Practice Address - Country:US
Practice Address - Phone:818-533-1449
Practice Address - Fax:818-505-9717
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA431124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist