Provider Demographics
NPI:1720099971
Name:BRINGHURST, G. LOUIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:G.
Middle Name:LOUIS
Last Name:BRINGHURST
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 1:1175 CALL PL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-3078
Mailing Address - Country:US
Mailing Address - Phone:208-232-1260
Mailing Address - Fax:208-232-2599
Practice Address - Street 1:1175 CALL PL
Practice Address - Street 2:SUITE 200
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-3078
Practice Address - Country:US
Practice Address - Phone:208-232-1260
Practice Address - Fax:208-232-2599
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD20291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice