Provider Demographics
NPI:1841345261
Name:BRINGHURST FAMILY DENTISTRY, PLLC
Entity type:Organization
Organization Name:BRINGHURST FAMILY DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINGHURST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-232-1260
Mailing Address - Street 1:1175 CALL PL STE 200
Mailing Address - Street 2:
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 STE 200
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental