Provider Demographics
NPI:1114048113
Name:BRUNELLI, ANTHONY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:M
Last Name:BRUNELLI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 KIETZKE LN STE 208
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2062
Mailing Address - Country:US
Mailing Address - Phone:775-852-1770
Mailing Address - Fax:775-852-2770
Practice Address - Street 1:5420 KIETZKE LN STE 208
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2062
Practice Address - Country:US
Practice Address - Phone:775-852-1770
Practice Address - Fax:775-852-2770
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2633122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist