Provider Demographics
NPI:1407907314
Name:BRUNELLI, ALAN J (DDS)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:J
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 1:1401S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:KAUFMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75142-3137
Mailing Address - Country:US
Mailing Address - Phone:972-932-2311
Mailing Address - Fax:
Practice Address - Street 1:701 N CENTRAL EXPY
Practice Address - Street 2:#4
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5342
Practice Address - Country:US
Practice Address - Phone:972-231-8241
Practice Address - Fax:972-231-8261
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX160381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD16038OtherBLUE CROSS BLUE SHIELD