Individual
JAKE DOUGLAS BRUSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
310 W LOSEY ST, SCOTT AFB, IL 62225-5250
(618) 256-2833
Mailing address
1695 LIEBCHEN CT, LAWRENCEBURG, IN 47025-9067
(513) 532-5923
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1205572245
IN
Other
Enumeration date
05/11/2022
Last updated
08/09/2023
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