Provider Demographics
NPI:1376661629
Name:BRUNICK, RON (DDS)
Entity Type:Individual
Prefix:DR
First Name:RON
Middle Name:
Last Name:BRUNICK
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 1:956 WALNUT ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-1707
Mailing Address - Country:US
Mailing Address - Phone:805-544-1941
Mailing Address - Fax:805-544-4727
Practice Address - Street 1:956 WALNUT ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-1707
Practice Address - Country:US
Practice Address - Phone:805-544-1941
Practice Address - Fax:805-544-4727
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA263021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice