Brian Gregory Lusk, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4517 Issued in WV

Practice address

6900 Alden Dr
Fe Warren Afb, WY 82005-2945

Phone

(307) 773-5623

NPI assigned

Mar 5, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1614902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661299200000",
    "number": "1831784339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 FORT WARREN AVE UNIT A",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820018265",
            "telephone_number": "304-923-7930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6900 ALDEN DR",
            "city": "FE WARREN AFB",
            "state": "WY",
            "postal_code": "820052945",
            "telephone_number": "307-773-5623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUSK",
        "first_name": "BRIAN",
        "middle_name": "GREGORY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-03-05",
        "last_updated": "2022-08-24",
        "certification_date": "2022-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WV",
            "license": "4517",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mallory Ann Krueger, DO
• Hallie Denise Landreth, PH D
• Haley Isham Lawson, PA-C
• Lisa Sung Eun Lee, PHARM D
• Shannon Freshwater Long, PA-C
• Jeanette Joan Lynch, LCSW
• Nicholas Robin Marshall, MSW
• Jonathan Scott Martino, DDS
• Windy Angelica Matthews, DMD
• Randall James Nett, MD

• General Practice Dentistry in Fe Warren Afb, WY
• Providers in Fe Warren Afb, WY by specialty
• General Practice Dentistry in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2022; 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.