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General NPI Number Information
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NPI Number | 1811663982
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Entity Type | Organization
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Legal Business Name | BEULAH FAMILY DENTISTRY , PLLC
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Dates
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Enumeration Date | 08/19/2021
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Last Update Date | 08/19/2021
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Provider Practice Location Address
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Address Line | 589 BEULAH HWY
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City | BEULAH
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State | MI
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Zip | 49617-8708
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Country | US
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Telephone | 248-974-8978
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Fax |
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Provider Business Mailing Address
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Address Line | 3986 HEATHERWOOD DR E
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-8615
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Country | US
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Telephone | 248-974-8978
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Fax |
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | DR. JOSHUA SHAW BRUDI
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Credential | DDS
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Telephone | 248-974-8978
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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