Provider Demographics
NPI:1548332679
Name:HIMELWRIGHT, BRIAN ELLIOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ELLIOTT
Last Name:HIMELWRIGHT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SHERIDAN SQ STE 100
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-7479
Mailing Address - Country:US
Mailing Address - Phone:423-247-7731
Mailing Address - Fax:423-247-7706
Practice Address - Street 1:8 SHERIDAN SQ STE 100
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7479
Practice Address - Country:US
Practice Address - Phone:423-247-7731
Practice Address - Fax:423-247-7706
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS6932122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist