Provider Demographics
NPI:1902934938
Name:BRUNETTI, JENNIFER N (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:N
Last Name:BRUNETTI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 GARNETT ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-3200
Mailing Address - Country:US
Mailing Address - Phone:678-546-1500
Mailing Address - Fax:678-546-5001
Practice Address - Street 1:600 GARNETT ST
Practice Address - Street 2:SUITE 3
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-3200
Practice Address - Country:US
Practice Address - Phone:678-546-1500
Practice Address - Fax:678-546-5001
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH219831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice