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General NPI Number Information
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NPI Number | 1043788482
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Entity Type | Organization
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Legal Business Name | BRUENING DENTAL LLC
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Dates
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Enumeration Date | 11/03/2018
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Last Update Date | 11/03/2018
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Provider Practice Location Address
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Address Line | 14377 WOODLAKE DR STE 206
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City | CHESTERFIELD
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State | MO
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Zip | 63017-5735
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Country | US
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Telephone | 314-878-8880
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Fax |
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Provider Business Mailing Address
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Address Line | 130 HILLTOWN VILLAGE CTR
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City | CHESTERFIELD
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State | MO
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Zip | 63017-0709
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. ANDREW ROGER BRUENING
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Credential | DDS
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Telephone | 636-448-1085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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