Provider Demographics
NPI:1770664567
Name:RUSK, BRADY DEE (DDS)
Entity Type:Individual
Prefix:
First Name:BRADY
Middle Name:DEE
Last Name:RUSK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 S OLD BETSY RD
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:TX
Mailing Address - Zip Code:76059
Mailing Address - Country:US
Mailing Address - Phone:817-641-2272
Mailing Address - Fax:817-641-2272
Practice Address - Street 1:104 S OLD BETSY RD
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:TX
Practice Address - Zip Code:76059
Practice Address - Country:US
Practice Address - Phone:817-641-2272
Practice Address - Fax:817-641-2272
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12703122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist