Provider Demographics
NPI:1306141692
Name:HUGH P. BRINDLEY, D.M.D., P.A.
Entity type:Organization
Organization Name:HUGH P. BRINDLEY, D.M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:P
Authorized Official - Last Name:BRINDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-838-3060
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-0190
Mailing Address - Country:US
Mailing Address - Phone:205-838-3060
Mailing Address - Fax:855-681-5911
Practice Address - Street 1:103 2ND AVE NE
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-2903
Practice Address - Country:US
Practice Address - Phone:256-734-4655
Practice Address - Fax:855-681-5911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29481223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000000695Medicaid
ALT68660Medicare UPIN
AL000090756Medicare PIN