Provider Demographics
NPI:1396729745
Name:BRUST, WILLIAM PATRICK (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:PATRICK
Last Name:BRUST
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 1:2606 HILLSIDE LN
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-1408
Mailing Address - Country:US
Mailing Address - Phone:425-353-1812
Mailing Address - Fax:425-252-8822
Practice Address - Street 1:4225 HOYT AVE
Practice Address - Street 2:STE D
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2318
Practice Address - Country:US
Practice Address - Phone:425-258-3622
Practice Address - Fax:425-252-8822
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA04860122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist