Provider Demographics
NPI:1174135446
Name:BRINDLE, CORBIN JAMES (DMD)
Entity type:Individual
Prefix:DR
First Name:CORBIN
Middle Name:JAMES
Last Name:BRINDLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:0610 SW NEVADA ST APT G
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-3069
Mailing Address - Country:US
Mailing Address - Phone:503-724-4897
Mailing Address - Fax:
Practice Address - Street 1:494 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-4919
Practice Address - Country:US
Practice Address - Phone:802-334-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016.0133964EMGY122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist