Healthcare Provider Details

I. General information

NPI: 1487598900
Provider Name (Legal Business Name): KARSON JUSTIN RUSH BRIONES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S VAL VISTA DR STE B7
GILBERT AZ
85296-1373
US

IV. Provider business mailing address

110 S VAL VISTA DR STE B7
GILBERT AZ
85296-1373
US

V. Phone/Fax

Practice location:
  • Phone: 480-569-2228
  • Fax:
Mailing address:
  • Phone: 480-569-2228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD012875
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: