Provider Demographics
NPI:1457045163
Name:FUERST, BRYAN (DDS)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:FUERST
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:253-681-6603
Mailing Address - Fax:
Practice Address - Street 1:6004 CAPITOL BLVD SE FL 1
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-8520
Practice Address - Country:US
Practice Address - Phone:360-522-9070
Practice Address - Fax:360-522-9077
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61439731122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2249977Medicaid