Provider Demographics
NPI:1659499481
Name:RON BRUNICK DDS,INC.
Entity Type:Organization
Organization Name:RON BRUNICK DDS,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-544-1941
Mailing Address - Street 1:956 WALNUT ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-1707
Mailing Address - Country:US
Mailing Address - Phone:805-544-1941
Mailing Address - Fax:805-544-4727
Practice Address - Street 1:956 WALNUT ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-1707
Practice Address - Country:US
Practice Address - Phone:805-544-1941
Practice Address - Fax:805-544-4727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA263021223G0001X
CA492021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTIN