MEDICARE: SARAH JALEEL BRUNELLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	10754	KY

General Provider Information

NPI Number	:	1477290773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH JALEEL BRUNELLE

Provider Business Mailing Address
First Line	:	2325 BUTTERMILK XING
Second Line	:
City	:	CRESCENT SPRINGS
State	:	KY
Zip	:	41017-1622
Country	:	US
Telephone Number	:	859-360-6776
Fax Number	:	859-360-3207

Provider Business Practice Location Address
First Line	:	2325 BUTTERMILK XING
Second Line	:
City	:	CRESCENT SPRINGS
State	:	KY
Zip	:	41017-1622
Country	:	US
Telephone Number	:	859-360-6776
Fax Number	:	859-360-3207

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2022
Last Update Date	:	02/10/2026

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