Provider Demographics
NPI:1376753772
Name:BRUNSON, LARRY EVERETT (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:EVERETT
Last Name:BRUNSON
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 1:10077 GROGANS MILL RD
Mailing Address - Street 2:SUITE 460
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1000
Mailing Address - Country:US
Mailing Address - Phone:281-292-1605
Mailing Address - Fax:281-292-7372
Practice Address - Street 1:10077 GROGANS MILL RD
Practice Address - Street 2:SUITE 460
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1000
Practice Address - Country:US
Practice Address - Phone:281-292-1605
Practice Address - Fax:281-292-7372
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX144711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice