Provider Demographics
NPI:1689399651
Name:RACHEL BRUNKER DDS LLC
Entity Type:Organization
Organization Name:RACHEL BRUNKER DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-529-9090
Mailing Address - Street 1:209 NW BLUE PKWY
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-1872
Mailing Address - Country:US
Mailing Address - Phone:816-529-9090
Mailing Address - Fax:816-246-0311
Practice Address - Street 1:209 NW BLUE PKWY
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-1872
Practice Address - Country:US
Practice Address - Phone:816-529-9090
Practice Address - Fax:816-246-0311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental