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General NPI Number Information
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NPI Number | 1760089619
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Entity Type | Individual
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Provider Name | DANIEL BRUMLEY DDS
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Gender | Male
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Dates
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Enumeration Date | 10/05/2020
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Last Update Date | 08/27/2021
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Provider Practice Location Address
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Address Line | 3400 MONTGOMERY HWY STE 1
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City | DOTHAN
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State | AL
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Zip | 36303-1270
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Country | US
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Telephone | 334-803-8700
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Fax |
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Provider Business Mailing Address
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Address Line | 4980 FLOWERS CHAPEL RD APT R123
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City | DOTHAN
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State | AL
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Zip | 36305-5317
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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 | 0006819-C1
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901601064
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License Number State | MI
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