Provider Demographics
NPI:1356564090
Name:BROUNER, GREG A (DDS)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:A
Last Name:BROUNER
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 1:1101 WEST MOANA LANE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4795
Mailing Address - Country:US
Mailing Address - Phone:775-825-9353
Mailing Address - Fax:775-825-9397
Practice Address - Street 1:1101 WEST MOANA LANE
Practice Address - Street 2:SUITE 4
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4795
Practice Address - Country:US
Practice Address - Phone:775-825-9353
Practice Address - Fax:775-825-9397
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7401223E0200X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223E0200XDental ProvidersDentistEndodontics
Not Answered1223G0001XDental ProvidersDentistGeneral Practice