Healthcare Provider Details

I. General information

NPI: 1497940415
Provider Name (Legal Business Name): RONALD BRUN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3711 PACIFIC AVE STE 300
TACOMA WA
98418-7800
US

IV. Provider business mailing address

3944 SW SOUTHERN ST
SEATTLE WA
98136-2342
US

V. Phone/Fax

Practice location:
  • Phone: 253-671-9966
  • Fax: 253-471-3540
Mailing address:
  • Phone: 206-235-9067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE00010828
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: