Provider Demographics
NPI:1871148775
Name:BRUSH UP DENTAL PC
Entity type:Organization
Organization Name:BRUSH UP DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:LIPSCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-673-5280
Mailing Address - Street 1:7000 FOREST AVE STE 800
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-1737
Mailing Address - Country:US
Mailing Address - Phone:804-673-5280
Mailing Address - Fax:
Practice Address - Street 1:7300 COSBY VILLAGE RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-1939
Practice Address - Country:US
Practice Address - Phone:804-821-0070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRUSH UP DENTAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental