Provider Demographics
NPI:1073863791
Name:BRUSH DENTISTRY PLLC
Entity Type:Organization
Organization Name:BRUSH DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:LIBLING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:682-231-2764
Mailing Address - Street 1:1100 N BLUE MOUND RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAGINAW
Mailing Address - State:TX
Mailing Address - Zip Code:76131-4901
Mailing Address - Country:US
Mailing Address - Phone:682-231-2764
Mailing Address - Fax:817-423-7483
Practice Address - Street 1:1100 N BLUE MOUND RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76131-4901
Practice Address - Country:US
Practice Address - Phone:682-231-2764
Practice Address - Fax:817-423-7483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26474261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental