Provider Demographics
NPI:1760670186
Name:BRUSH DENTAL HYGIENE
Entity Type:Organization
Organization Name:BRUSH DENTAL HYGIENE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MORREALE
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:970-842-0220
Mailing Address - Street 1:PO BOX 563
Mailing Address - Street 2:
Mailing Address - City:BRUSH
Mailing Address - State:CO
Mailing Address - Zip Code:80723-0563
Mailing Address - Country:US
Mailing Address - Phone:970-842-0220
Mailing Address - Fax:970-842-0224
Practice Address - Street 1:412 EDISON ST
Practice Address - Street 2:
Practice Address - City:BRUSH
Practice Address - State:CO
Practice Address - Zip Code:80723-2130
Practice Address - Country:US
Practice Address - Phone:970-842-0220
Practice Address - Fax:970-842-0224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO904552261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01335537Medicaid