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General NPI Number Information
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NPI Number | 1861051260
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Entity Type | Individual
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Provider Name | VIVEK BRAHMBHATT
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Gender | Male
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Dates
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Enumeration Date | 06/10/2019
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Last Update Date | 06/10/2019
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Provider Practice Location Address
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Address Line | 11460 US HIGHWAY 431
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City | GUNTERSVILLE
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State | AL
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Zip | 35976-5747
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Country | US
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Telephone | 256-763-0915
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Fax |
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Provider Business Mailing Address
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Address Line | 520 SUMMIT PL
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City | BIRMINGHAM
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State | AL
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Zip | 35243-3111
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Country | US
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Telephone | 678-704-3617
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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 | 0006646-C1
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License Number State | AL
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