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General NPI Number Information
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NPI Number | 1578791257
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Entity Type | Individual
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Provider Name | TODD G BRINGHURST D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/01/2009
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Last Update Date | 07/01/2009
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Provider Practice Location Address
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Address Line | BLDG. H 2005 KNIGHT LANE NAVY MEDICINE SUPPORT COMMAND; ATTN: MEDICAL STAFF SVCS
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City | JACKSONVILLE
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State | FL
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Zip | 32212-0140
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Country | US
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Telephone | 801-380-7666
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Fax |
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Provider Business Mailing Address
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Address Line | 334 S 400 E APT 18
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City | CEDAR CITY
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State | UT
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Zip | 84720-3473
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Country | US
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Telephone |
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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 | 58378
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License Number State | CA
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