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General NPI Number Information
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NPI Number | 1467804583
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Entity Type | Individual
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Provider Name | JASON BRIMLEY DMD
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Gender | Male
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Dates
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Enumeration Date | 07/13/2016
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Last Update Date | 02/06/2023
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Provider Practice Location Address
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Address Line | 1091 N BLUFF ST STE 812
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City | ST GEORGE
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State | UT
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Zip | 84770-7054
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Country | US
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Telephone | 435-688-2772
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Fax |
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Provider Business Mailing Address
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Address Line | 1091 N BLUFF ST STE 812
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City | ST GEORGE
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State | UT
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Zip | 84770-7054
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Country | US
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Telephone | 435-688-2772
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D009512
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12888079-8903
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License Number State | UT
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