Provider Demographics
NPI:1679621379
Name:BRUNERR, RONALD ALCORN (DDS)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:ALCORN
Last Name:BRUNERR
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 1:255 E LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT ROBERT
Mailing Address - State:MO
Mailing Address - Zip Code:65584-3702
Mailing Address - Country:US
Mailing Address - Phone:573-336-5563
Mailing Address - Fax:573-336-5916
Practice Address - Street 1:255 E LAWN AVE
Practice Address - Street 2:
Practice Address - City:SAINT ROBERT
Practice Address - State:MO
Practice Address - Zip Code:65584-3702
Practice Address - Country:US
Practice Address - Phone:573-336-5563
Practice Address - Fax:573-336-5916
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO119861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice