Healthcare Provider Details

I. General information

NPI: 1831292499
Provider Name (Legal Business Name): BRUMMETT COSMETIC AND FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 N MAIN ST
MONTICELLO KY
42633-1902
US

IV. Provider business mailing address

1225 N MAIN ST
MONTICELLO KY
42633-1902
US

V. Phone/Fax

Practice location:
  • Phone: 606-340-0740
  • Fax: 606-340-0742
Mailing address:
  • Phone: 606-340-0740
  • Fax: 606-340-0742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8228
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8228
License Number StateKY

VIII. Authorized Official

Name: DANIEL JAMES BRUMMETT
Title or Position: OWNER
Credential: DMD
Phone: 606-340-0740