Provider Demographics
NPI:1942561253
Name:GRUNES, BRANDON DAVID (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:DAVID
Last Name:GRUNES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SHADY OAK LN
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-3028
Mailing Address - Country:US
Mailing Address - Phone:508-333-4331
Mailing Address - Fax:
Practice Address - Street 1:230 POND ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-4323
Practice Address - Country:US
Practice Address - Phone:508-653-2417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18562221223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry