MEDICARE: BRUSH UP DENTAL PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1871148775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRUSH UP DENTAL PC

Provider Business Mailing Address
First Line	:	7000 FOREST AVE STE 800
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-1737
Country	:	US
Telephone Number	:	804-673-5280
Fax Number	:

Provider Business Practice Location Address
First Line	:	7300 COSBY VILLAGE RD
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-1939
Country	:	US
Telephone Number	:	804-821-0070
Fax Number	:

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. JASON TODD LIPSCOMB
Credential	:	DDS
Telephone Number	:	804-673-5280

Provider Enumeration Date	:	08/07/2019
Last Update Date	:	08/07/2019

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Directions to “BRUSH UP DENTAL PC ” Practice Location

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