Provider Demographics
NPI:1922210855
Name:DEBRUHL, BRANK B (DENTIST DDS)
Entity type:Individual
Prefix:MR
First Name:BRANK
Middle Name:B
Last Name:DEBRUHL
Suffix:
Gender:M
Credentials:DENTIST DDS
Other - Prefix:DR
Other - First Name:BRANK
Other - Middle Name:B
Other - Last Name:DEBRUHL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4573 EAST STATE RD 236
Mailing Address - Street 2:BRANK B DEBRUHL DDS
Mailing Address - City:MIDDLETOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47356
Mailing Address - Country:US
Mailing Address - Phone:765-354-4796
Mailing Address - Fax:765-354-4794
Practice Address - Street 1:4573 EAST STATE RD 236
Practice Address - Street 2:BRANK B DEBRUHL DDS
Practice Address - City:MIDDLETOWN
Practice Address - State:IN
Practice Address - Zip Code:47356
Practice Address - Country:US
Practice Address - Phone:765-354-4796
Practice Address - Fax:765-354-4794
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN69331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice