Provider Demographics
NPI:1083714562
Name:BRUNK, MARY STRUBLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:STRUBLE
Last Name:BRUNK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:MARTHA
Other - Last Name:STRUBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3513 WESTMINSTER AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-1210
Mailing Address - Country:US
Mailing Address - Phone:214-361-9558
Mailing Address - Fax:
Practice Address - Street 1:6805 HILLCREST AVE
Practice Address - Street 2:SUITE 218
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-1396
Practice Address - Country:US
Practice Address - Phone:214-750-4901
Practice Address - Fax:214-750-7408
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16703122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist