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General NPI Number Information
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NPI Number | 1679267116
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Entity Type | Individual
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Provider Name | GUNNER LANE BRANTLEY DDS
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Gender | Male
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Dates
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Enumeration Date | 06/07/2023
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 511 N RIDGEVIEW DR
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City | WARRENSBURG
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State | MO
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Zip | 64093-9336
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Country | US
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Telephone | 660-747-9117
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Fax |
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Provider Business Mailing Address
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Address Line | 400 RIVERWALK TER STE 250
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City | JENKS
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State | OK
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Zip | 74037-5619
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Country | US
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Telephone | 918-998-0996
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7910
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2024038491
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License Number State | MO
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