Provider Demographics
NPI:1629268347
Name:BRUNSON, J. TODD (DDS)
Entity Type:Individual
Prefix:DR
First Name:J.
Middle Name:TODD
Last Name:BRUNSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:J.
Other - Middle Name:TODD
Other - Last Name:BRUNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:372 CYPRESS POINT DR
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-1713
Mailing Address - Country:US
Mailing Address - Phone:760-413-2828
Mailing Address - Fax:
Practice Address - Street 1:372 CYPRESS POINT DR
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-1713
Practice Address - Country:US
Practice Address - Phone:760-413-2828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4411631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice