Organization
BRUSH DENTAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. THERESE GONZALES RDH (OWNER)
(970) 842-0220
Entity
Organization
Contact information
Practice address
412 EDISON ST, BRUSH, CO 80723-2130
(970) 842-0220
(970) 842-0224
Mailing address
412 EDISON ST, BRUSH, CO 80723
(970) 842-0220
(970) 842-0224
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
904552
CO
261QD0000X
Dental Clinic/Center
Primary
904552
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01335537
—
CO
Enumeration date
06/02/2016
Last updated
02/08/2017
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