Provider Demographics
NPI:1578789939
Name:ROBERT. L. BRUNKER, D.D.S., P.C.
Entity Type:Organization
Organization Name:ROBERT. L. BRUNKER, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BRUNKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-364-1186
Mailing Address - Street 1:103 S 36TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2920
Mailing Address - Country:US
Mailing Address - Phone:816-364-1186
Mailing Address - Fax:816-364-1186
Practice Address - Street 1:103 S 36TH ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2920
Practice Address - Country:US
Practice Address - Phone:816-364-1186
Practice Address - Fax:816-364-1186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0130911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty