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General NPI Number Information
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NPI Number | 1962780916
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Entity Type | Organization
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Legal Business Name | JEAN-DANIEL BRUTUS D.D.S., LLC
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Dates
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Enumeration Date | 07/25/2011
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Last Update Date | 07/25/2011
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Provider Practice Location Address
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Address Line | 6000 LAUREL BOWIE RD SUITE 101
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City | BOWIE
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State | MD
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Zip | 20715-4000
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Country | US
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Telephone | 301-262-1112
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Fax | 301-262-2237
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Provider Business Mailing Address
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Address Line | 6000 LAUREL BOWIE RD SUITE 101
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City | BOWIE
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State | MD
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Zip | 20715-4000
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Country | US
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Telephone | 301-262-1112
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Fax | 301-262-2237
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. JEAN-DANIEL BRUTUS
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Credential | DDS
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Telephone | 301-262-1112
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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 | 13673
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License Number State | MD
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