Brimacombe, Corey Lee

Brimacombe, Corey Lee is an individual health care provider with primary practice located at 413 N 17Th Ave , Wausau WI 54401-4226. He recently has only one registered license in Dental Providers / Pediatric Dentistry, which is considered as his primary health care specialty. Brimacombe, Corey Lee can be contacted via phone (715) 842-4649.

Contact Information

Primary practice address
413 N 17Th Ave Wausau WI 54401-4226
Phone: (715) 842-4649
Fax: (715) 842-7331
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Pediatric Dentistry 1223P0221X 5059 Wisconsin

Profile Details

NPI number 1659596153
LBN Legal business name Brimacombe, Corey Lee
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 17th, 2007
Last updated Jul 9th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1659596153 NPPES
Wisconsin Other 5059 DELTA WI ID#
Wisconsin MEDICAID 33756600 DELTA WI ID#

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