Provider Demographics
NPI:1801838875
Name:BRUNNER, BRANDON ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:ANDREW
Last Name:BRUNNER
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 1:1508 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-1912
Mailing Address - Country:US
Mailing Address - Phone:414-803-7991
Mailing Address - Fax:
Practice Address - Street 1:125 N EXECUTIVE DR
Practice Address - Street 2:SUITE 105
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-6070
Practice Address - Country:US
Practice Address - Phone:262-784-7201
Practice Address - Fax:262-784-0542
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5526-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice