MEDICARE: DR. CHRISTOPHER MARK BRINGHURST DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	5093	NV

General Provider Information

NPI Number	:	1861580094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER MARK BRINGHURST DMD

Provider Business Mailing Address
First Line	:	2650 LAKE SAHARA DR STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-3451
Country	:	US
Telephone Number	:	702-562-0000
Fax Number	:	702-562-3504

Provider Business Practice Location Address
First Line	:	2650 LAKE SAHARA DR STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-3451
Country	:	US
Telephone Number	:	702-562-0000
Fax Number	:	702-562-3504

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	09/01/2009

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