Provider Demographics
NPI:1952737157
Name:BRUNE, LANCE MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:MICHAEL
Last Name:BRUNE
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 1:3309 LAKESHORE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2305
Mailing Address - Country:US
Mailing Address - Phone:510-444-4331
Mailing Address - Fax:
Practice Address - Street 1:3309 LAKESHORE AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2305
Practice Address - Country:US
Practice Address - Phone:510-444-4331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0569061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice