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General NPI Number Information
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NPI Number | 1194273573
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Entity Type | Organization
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Legal Business Name | MICHAEL J. BRUNNER, DDS, PC
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Dates
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Enumeration Date | 09/14/2016
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Last Update Date | 09/14/2016
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Provider Practice Location Address
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Address Line | 315 S HOWELL ST
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City | PINCKNEY
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State | MI
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Zip | 48169-7900
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Country | US
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Telephone | 734-878-3167
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Fax | 734-878-3168
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Provider Business Mailing Address
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Address Line | 315 S HOWELL ST
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City | PINCKNEY
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State | MI
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Zip | 48169-7900
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Country | US
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Telephone | 734-878-3167
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Fax | 734-878-3168
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ELIZABETH PRAST
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Credential | D.D.S.
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Telephone | 734-878-3167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901020228
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 13128
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License Number State | MI
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