Provider Demographics
NPI:1902063191
Name:GREGORY J. BRUNS, DDS
Entity Type:Organization
Organization Name:GREGORY J. BRUNS, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIS
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRUNS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:641-792-2148
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:112 FIRST AVE. E.
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-0068
Mailing Address - Country:US
Mailing Address - Phone:641-792-2148
Mailing Address - Fax:
Practice Address - Street 1:112 1ST AVE E
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-3742
Practice Address - Country:US
Practice Address - Phone:641-792-2148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6124122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty