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General NPI Number Information
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NPI Number | 1912170341
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Entity Type | Organization
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Legal Business Name | KENNETH L. BRUNSON, DDS, MS, PC
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Dates
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Enumeration Date | 04/07/2008
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Last Update Date | 04/07/2008
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Provider Practice Location Address
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Address Line | 1950 US HIGHWAY 51 BYP N SUITE A
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City | DYERSBURG
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State | TN
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Zip | 38024-1896
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Country | US
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Telephone | 731-285-9657
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Fax | 731-285-0055
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Provider Business Mailing Address
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Address Line | 1950 US HIGHWAY 51 BYP N SUITE A
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City | DYERSBURG
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State | TN
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Zip | 38024-1896
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Country | US
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Telephone | 731-285-9657
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Fax | 731-285-0055
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. KENNETH L BRUNSON
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Credential | DDS, MS
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Telephone | 731-285-9657
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DS1826
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License Number State | TN
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