MEDICARE: DR. THOMAS DEL BRUSS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	8665	MN

General Provider Information

NPI Number	:	1689741951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS DEL BRUSS DDS

Provider Business Mailing Address
First Line	:	4201 MINNEHAHA AVE SO
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	54406-3303
Country	:	US
Telephone Number	:	612-721-2833
Fax Number	:	612-721-4356

Provider Business Practice Location Address
First Line	:	4201 MINNEHAHA AVE SO
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	54406-3303
Country	:	US
Telephone Number	:	612-721-2833
Fax Number	:	612-721-4356

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/08/2007

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