Brushes and Brackets Dental Studio

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

BRUSHES AND BRACKETS DENTAL STUDIO

Doing business as

Brushes and Brackets Dental Studio

Practice address

2255 Dunn Ave Ste 700
Jacksonville, FL 32218-4742

Phone

(904) 751-5126

Fax

(904) 751-5146

NPI assigned

Oct 28, 2021

Last updated

Oct 28, 2021By the provider in NPPES

Organization subpart

Yes

Parent organization

BRUSHES AND BRACKETS DENTAL STUDIOAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Tanya Wall, DDSNPI 1063528586

Title

Owner

Phone

(904) 751-5126

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Brushes and Brackets Dental Studio Doing business as

Electronic endpoints 1

Part of

Brushes and Brackets Dental

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tanya C Wall, DDS

  • Pediatric Dentistry
  • Jacksonville, FL
  • NPI 1063528586
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1635379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635379200000",
    "number": "1023772704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2255 DUNN AVE STE 700",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322184742",
            "telephone_number": "904-751-5126",
            "fax_number": "904-751-5146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2255 DUNN AVE STE 700",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322184742",
            "telephone_number": "904-751-5126",
            "fax_number": "904-751-5146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRUSHES AND BRACKETS DENTAL STUDIO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BRUSHES AND BRACKETS DENTAL STUDIO",
        "enumeration_date": "2021-10-28",
        "last_updated": "2021-10-28",
        "certification_date": "2021-10-28",
        "status": "A",
        "authorized_official_last_name": "WALL",
        "authorized_official_first_name": "TANYA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-751-5126",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103221100",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "computers,email",
            "affiliation": "N",
            "endpointDescription": "computers,email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "2255 Dunn Ave Ste 700",
            "city": "Jacksonville",
            "state": "FL",
            "country_code": "US",
            "postal_code": "322184742",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Brushes and Brackets Dental Studio",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jessica Bruno, OTR/L
• Juanita Claudian Bruno, LMFT
• Thomas James Bruno
• Christopher Brunson, CAP 5938
• Jazmyne Brunson
• Betty Regina Bryan
• Coleman J Bryan Jr., M.D., MSPH
• David Michael Bryan, PHARM.D.
• Elizabeth Jo Bryan
• Grace Bryan, PAC

• Dental Clinic/Center in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Dental Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.