Provider Demographics
NPI:1760122378
Name:BRUNET DENTAL LLC
Entity Type:Organization
Organization Name:BRUNET DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF BUISNESS
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRUNET
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-678-3170
Mailing Address - Street 1:702 W SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:OH
Mailing Address - Zip Code:45828-1623
Mailing Address - Country:US
Mailing Address - Phone:419-678-3170
Mailing Address - Fax:
Practice Address - Street 1:702 W SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:OH
Practice Address - Zip Code:45828-1623
Practice Address - Country:US
Practice Address - Phone:419-678-3170
Practice Address - Fax:419-678-3919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1124683073OtherNPI TYPE I