Provider Demographics
NPI:1427198860
Name:BRUNS, JOLENE KAY
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:KAY
Last Name:BRUNS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:INWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51240
Mailing Address - Country:US
Mailing Address - Phone:712-753-2323
Mailing Address - Fax:
Practice Address - Street 1:213 S MAIN ST
Practice Address - Street 2:
Practice Address - City:INWOOD
Practice Address - State:IA
Practice Address - Zip Code:51240
Practice Address - Country:US
Practice Address - Phone:712-753-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA68601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice