Provider Demographics
NPI:1982742938
Name:BRUNETTI, JOHN (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BRUNETTI
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 1:1 E PHILLIP RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1858
Mailing Address - Country:US
Mailing Address - Phone:847-367-4190
Mailing Address - Fax:847-367-5010
Practice Address - Street 1:1 E PHILLIP RD
Practice Address - Street 2:SUITE 101
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1858
Practice Address - Country:US
Practice Address - Phone:847-367-4190
Practice Address - Fax:847-367-5010
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0210022761223S0112X
IL0190258901223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery