Provider Demographics
NPI:1225281447
Name:BRUNNETT, JESSICA SHEDLOCK (DDS)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:SHEDLOCK
Last Name:BRUNNETT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 LA SALLE RD
Mailing Address - Street 2:OXFORD BUILDING SUITE 611
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-2001
Mailing Address - Country:US
Mailing Address - Phone:410-823-5010
Mailing Address - Fax:410-823-5557
Practice Address - Street 1:8600 LA SALLE RD
Practice Address - Street 2:OXFORD BUILDING SUITE 611
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-2001
Practice Address - Country:US
Practice Address - Phone:410-823-5010
Practice Address - Fax:410-823-5557
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14096122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist