Provider Demographics
NPI:1245476571
Name:JEFFREY J BRUS DMD PLLC
Entity type:Organization
Organization Name:JEFFREY J BRUS DMD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRUS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:253-845-1600
Mailing Address - Street 1:16021 MERIDIAN E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-9605
Mailing Address - Country:US
Mailing Address - Phone:253-845-1600
Mailing Address - Fax:
Practice Address - Street 1:16021 MERIDIAN E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-9605
Practice Address - Country:US
Practice Address - Phone:253-845-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00006838122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty