MEDICARE: BRUMFIELD & WEISBROT DENTISTRY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	0022011	OH
2	261QD0000X	Dental Clinic/Center	0021202	OH

General Provider Information

NPI Number	:	1174822175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRUMFIELD & WEISBROT DENTISTRY, LLC

Provider Business Mailing Address
First Line	:	910 LOVELAND MADEIRA RD
Second Line	:
City	:	LOVELAND
State	:	OH
Zip	:	45140-2795
Country	:	US
Telephone Number	:	513-683-4040
Fax Number	:	513-697-2312

Provider Business Practice Location Address
First Line	:	910 LOVELAND MADEIRA RD
Second Line	:
City	:	LOVELAND
State	:	OH
Zip	:	45140-2795
Country	:	US
Telephone Number	:	513-683-4040
Fax Number	:	513-697-2312

Authorized Official
Title or Position	:	PARTNER DENTIST
Name	:	DR. MOLLY BRUMFIELD
Credential	:	D.D.S.
Telephone Number	:	513-683-4040

Provider Enumeration Date	:	03/16/2011
Last Update Date	:	03/16/2011

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