Provider Demographics
NPI:1760231005
Name:JOHN C BRUMMER DDS PA
Entity type:Organization
Organization Name:JOHN C BRUMMER DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRUMMER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-409-9501
Mailing Address - Street 1:3511 CEDAR HAMMOCK VIEW CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-5869
Mailing Address - Country:US
Mailing Address - Phone:410-409-9501
Mailing Address - Fax:
Practice Address - Street 1:6304 KENWOOD AVE STE 5
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-4918
Practice Address - Country:US
Practice Address - Phone:410-866-3630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty