Provider Demographics
NPI:1609073790
Name:DR. JOHN W. BRUNS, D.D.S. INC
Entity Type:Organization
Organization Name:DR. JOHN W. BRUNS, D.D.S. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRUNS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-934-7755
Mailing Address - Street 1:2021 YGNACIO VALLEY RD
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3391
Mailing Address - Country:US
Mailing Address - Phone:925-934-7755
Mailing Address - Fax:925-934-4246
Practice Address - Street 1:2021 YGNACIO VALLEY RD
Practice Address - Street 2:SUITE A-2
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3391
Practice Address - Country:US
Practice Address - Phone:925-934-7755
Practice Address - Fax:925-934-4246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251051223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty