Corey Lee Brimacombe, D.D.S

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

5059 Issued in WI

Practice address

413 N 17TH Ave
Wausau, WI 54401-4226

Phone

(715) 842-4649

Fax

(715) 842-7331

NPI assigned

Apr 17, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1659596153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "413 N 17TH AVE",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544014226",
            "telephone_number": "715-842-4649",
            "fax_number": "715-842-7331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 N 17TH AVE",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544014226",
            "telephone_number": "715-842-4649",
            "fax_number": "715-842-7331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRIMACOMBE",
        "first_name": "COREY",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-17",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "WI",
            "license": "5059",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA WI ID#",
            "identifier": "5059",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33756600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Debra Lynn Breunling, PT
• Aliya Brianne, LPC-IT
• Marie Brick
• Michaella Brickner
• Jace Briggs, CPO
• Julie A Brinkman, RN
• Sharon Brinkman, CRNA
• Holly K Briquelet Miller
• Lynda Broschardt, LPC
• Brotkowski Acquisitions LLC

• Pediatric Dentistry in Wausau, WI
• Providers in Wausau, WI by specialty
• Pediatric Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.