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DR. KENNETH J BRUST
General Practice >> Dentist >> Dental ProvidersRegistrant NPI Number: 1821207507
Individual Registrant:DR. KENNETH J BRUST
Gender: M
Sole Proprietor
Gender: M
Sole Proprietor
Location and contact information for practice:
16990 MAIN ST SUITE 1 HESPERIA, CA 92345-7919 US
Tel: 760-244-7232 Fax: --
Tel: 760-244-7232 Fax: --
Contact information for business:
16990 MAIN ST SUITE 1 HESPERIA, CA 92345-7919 US
Tel: -- Fax: --
Tel: -- Fax: --
Registration Information:
NPI: 1821207507
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 1223G0001X | Dental Providers Dentist General Practice | CA | 43905 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
