Provider Demographics
NPI:1003941568
Name:HAUG- BRUSH, CYNTHIA DICKSON (DMD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:DICKSON
Last Name:HAUG- BRUSH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13005 SW 1ST RD, STE 233
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32669
Mailing Address - Country:US
Mailing Address - Phone:352-333-1946
Mailing Address - Fax:352-333-9112
Practice Address - Street 1:13005 SW 1ST RD, STE 233
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32669
Practice Address - Country:US
Practice Address - Phone:352-333-1946
Practice Address - Fax:352-333-9112
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN151731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice