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General NPI Number Information
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NPI Number | 1174695522
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Entity Type | Organization
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Legal Business Name | ERIC W. BRUST DDS PC
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 10/22/2014
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Provider Practice Location Address
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Address Line | 10460 PELHAM RD
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City | TAYLOR
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State | MI
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Zip | 48180-3828
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Country | US
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Telephone | 313-299-9700
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Fax | 313-299-9951
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Provider Business Mailing Address
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Address Line | 10460 PELHAM RD
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City | TAYLOR
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State | MI
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Zip | 48180-3828
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Country | US
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Telephone | 313-299-9700
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Fax | 313-299-9951
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Authorized Official
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Title or Position | OWNER
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Name | DR. ERIC W BRUST
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Credential | DDS MS
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Telephone | 313-299-9700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 15547
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License Number State | MI
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