Provider Demographics
NPI:1811266620
Name:BRUNER, CARRIE LEANNE (RDH)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:LEANNE
Last Name:BRUNER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 N 67TH PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6082
Mailing Address - Country:US
Mailing Address - Phone:480-949-1950
Mailing Address - Fax:480-994-1193
Practice Address - Street 1:3030 N 67TH PL
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6082
Practice Address - Country:US
Practice Address - Phone:480-949-1950
Practice Address - Fax:480-994-1193
Is Sole Proprietor?:No
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH02647124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist