Provider Demographics
NPI:1982784450
Name:BRIMHALL, CHARLES I (DDS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:I
Last Name:BRIMHALL
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 1:85 W 500 N
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-2831
Mailing Address - Country:US
Mailing Address - Phone:801-373-4878
Mailing Address - Fax:801-717-3502
Practice Address - Street 1:85 W 500 N
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-2831
Practice Address - Country:US
Practice Address - Phone:801-373-4878
Practice Address - Fax:801-717-3502
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1435881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice