Healthcare Provider Details

I. General information

NPI: 1770777195
Provider Name (Legal Business Name): JAMES A BRUSKY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 MONROE AVE
GREEN BAY WI
54301
US

IV. Provider business mailing address

1586 ARAPAHOE CT
GREEN BAY WI
54313
US

V. Phone/Fax

Practice location:
  • Phone: 920-448-7340
  • Fax:
Mailing address:
  • Phone: 920-494-7907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number5000607-015
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: