Provider Demographics
NPI:1356549414
Name:BRUMMER, BENJAMIN E (DDS DENTIST)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:E
Last Name:BRUMMER
Suffix:
Gender:M
Credentials:DDS DENTIST
Other - Prefix:DR
Other - First Name:B
Other - Middle Name:E
Other - Last Name:BRUMMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS DENTIST
Mailing Address - Street 1:PO 160
Mailing Address - Street 2:116 N MAIN
Mailing Address - City:STANDISH
Mailing Address - State:MI
Mailing Address - Zip Code:48658
Mailing Address - Country:US
Mailing Address - Phone:989-846-6981
Mailing Address - Fax:989-846-6991
Practice Address - Street 1:116 N MAIN
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:MI
Practice Address - Zip Code:48658
Practice Address - Country:US
Practice Address - Phone:989-846-6981
Practice Address - Fax:989-846-6991
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010092151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice