Provider Demographics
NPI:1215084421
Name:BRUS, JEFFREY J (DMD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:J
Last Name:BRUS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:253-845-5760
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:253-845-5760
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA68381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice