Provider Demographics
NPI:1861215394
Name:BRUM LLC
Entity type:Organization
Organization Name:BRUM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABBEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-839-2273
Mailing Address - Street 1:439 N CENTENNIAL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST FORK
Mailing Address - State:AR
Mailing Address - Zip Code:72774-2708
Mailing Address - Country:US
Mailing Address - Phone:479-839-2273
Mailing Address - Fax:
Practice Address - Street 1:439 N CENTENNIAL AVE
Practice Address - Street 2:
Practice Address - City:WEST FORK
Practice Address - State:AR
Practice Address - Zip Code:72774-2708
Practice Address - Country:US
Practice Address - Phone:479-839-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRUM LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental