Individual
JAE BRIMHALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD, MS
Contact information
Practice address
3123 GREEN MEADOW DR, SAN ANGELO, TX 76904-6977
(325) 208-4654
Mailing address
409 AVALON LN, COPPELL, TX 75019-7579
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
9033
KY
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
34865
TX
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
DEN00202177
CO
Other
Enumeration date
10/03/2011
Last updated
10/18/2024
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