MEDICARE: ROBERT DAVID BRUMBAUGH DDS, PA

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	1223G0001X	General Practice Dentistry	19837	TX

General Provider Information

NPI Number	:	1891884839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT DAVID BRUMBAUGH DDS, PA

Provider Business Mailing Address
First Line	:	3131 HARVARD AVE
Second Line	:	105
City	:	DALLAS
State	:	TX
Zip	:	75205-3437
Country	:	US
Telephone Number	:	214-520-8821
Fax Number	:	214-520-8922

Provider Business Practice Location Address
First Line	:	3131 HARVARD AVE
Second Line	:	105
City	:	DALLAS
State	:	TX
Zip	:	75205-3443
Country	:	US
Telephone Number	:	214-520-8821
Fax Number	:	214-520-8922

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/08/2007

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