Provider Demographics
NPI:1053782599
Name:BRUSH: A FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:BRUSH: A FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEREA
Authorized Official - Middle Name:B
Authorized Official - Last Name:RACHAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:318-542-4004
Mailing Address - Street 1:PO BOX 12848
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71315-2848
Mailing Address - Country:US
Mailing Address - Phone:318-540-4004
Mailing Address - Fax:
Practice Address - Street 1:2227 WORLEY DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3631
Practice Address - Country:US
Practice Address - Phone:318-542-4004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-09
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA59131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty