Provider Demographics
NPI:1205051984
Name:DR.WILLIAM PATRICK BRUST
Entity type:Organization
Organization Name:DR.WILLIAM PATRICK BRUST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:BRUST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-258-3622
Mailing Address - Street 1:2606 HILLSIDE LN
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-1408
Mailing Address - Country:US
Mailing Address - Phone:425-353-1812
Mailing Address - Fax:
Practice Address - Street 1:4225 HOYT AVE STE D
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2351
Practice Address - Country:US
Practice Address - Phone:425-258-3622
Practice Address - Fax:425-252-8822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA04860122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty