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General NPI Number Information
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NPI Number | 1760670186
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Entity Type | Organization
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Legal Business Name | BRUSH DENTAL HYGIENE
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Dates
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Enumeration Date | 10/10/2007
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Last Update Date | 10/10/2007
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Provider Practice Location Address
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Address Line | 412 EDISON ST
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City | BRUSH
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State | CO
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Zip | 80723-2130
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Country | US
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Telephone | 970-842-0220
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Fax | 970-842-0224
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Provider Business Mailing Address
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Address Line | PO BOX 563
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City | BRUSH
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State | CO
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Zip | 80723-0563
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Country | US
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Telephone | 970-842-0220
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Fax | 970-842-0224
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Authorized Official
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Title or Position | OWNER
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Name | MRS. TERRI ANN MORREALE
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Credential | R.D.H.
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Telephone | 970-842-0220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 904552
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License Number State | CO
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