Provider Demographics
NPI:1629192265
Name:BRUNTJEN, BARTON LANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BARTON
Middle Name:LANE
Last Name:BRUNTJEN
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 1:400 S COUNTY FARM RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-4547
Mailing Address - Country:US
Mailing Address - Phone:630-653-8850
Mailing Address - Fax:630-653-3644
Practice Address - Street 1:400 S COUNTY FARM RD
Practice Address - Street 2:SUITE 210
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-4547
Practice Address - Country:US
Practice Address - Phone:630-653-8850
Practice Address - Fax:630-653-3644
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0206311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice