Provider Demographics
NPI:1902893209
Name:BRUNNER, DAVID J (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:BRUNNER
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 1:10345 N PORT WASHINGTON RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-5762
Mailing Address - Country:US
Mailing Address - Phone:262-240-1200
Mailing Address - Fax:
Practice Address - Street 1:10345 N PORT WASHINGTON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5762
Practice Address - Country:US
Practice Address - Phone:262-240-1200
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50008811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice