| Organization Name: | BRUSH DENTISTRY LLC |
| NPI Number: | 1063899771 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HUNTER JAKE HANUS (OWNER/PRESIDENT) |
| Mailing Address: | 14617 S Memorial Dr Bixby |
| State: | OK US |
| Postal Code: | 740083767 |
| Phone Number: | 9183669500 |
| Fax Number: | |
| NPI Enumeration Date: | 05/01/2015 |
| NPI Last Update Date: | 05/01/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 6589 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |