Provider Demographics
NPI:1679793046
Name:BRUENING, SHAWN MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:MARIE
Last Name:BRUENING
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 MONTE VISTA AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-2962
Mailing Address - Country:US
Mailing Address - Phone:909-981-6200
Mailing Address - Fax:909-981-6255
Practice Address - Street 1:1601 MONTE VISTA AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-2962
Practice Address - Country:US
Practice Address - Phone:909-981-6200
Practice Address - Fax:909-981-6255
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51233122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist