# BRUK WEYMOUTH

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1568683688
- **Gender:** Man

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 2091 | MT | Yes |

## Other

- **Enumeration date:** 05/02/2007
- **Last updated:** 07/08/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0112829 | — | MT |
| 01 | — | 2091 | DENTAL LICENSE \# | MT |
| 01 | — | 20914 | BCBS \# | MT |
| 01 | — | 5512386 | CHIP \# | MT |