Provider Demographics
NPI:1386866986
Name:BRUNSWICK FAMILY DENTAL PRACTICE INC
Entity Type:Organization
Organization Name:BRUNSWICK FAMILY DENTAL PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:GULBRANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-273-1600
Mailing Address - Street 1:3487 CENTER ROAD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212
Mailing Address - Country:US
Mailing Address - Phone:330-273-1600
Mailing Address - Fax:330-225-7687
Practice Address - Street 1:3487 CENTER ROAD
Practice Address - Street 2:SUITE 8
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212
Practice Address - Country:US
Practice Address - Phone:330-273-1600
Practice Address - Fax:330-225-7687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental