MEDICARE: DR. BETH BRUNNER DMD, MD, PLLC

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	054553	NY

General Provider Information

NPI Number	:	1649432139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETH BRUNNER DMD, MD, PLLC

Provider Business Mailing Address
First Line	:	1936 SARANAC AVE
Second Line	:	SUITE 101
City	:	LAKE PLACID
State	:	NY
Zip	:	12946-1114
Country	:	US
Telephone Number	:	518-837-5019
Fax Number	:	518-837-5093

Provider Business Practice Location Address
First Line	:	1936 SARANAC AVE
Second Line	:	SUITE 101
City	:	LAKE PLACID
State	:	NY
Zip	:	12946-1114
Country	:	US
Telephone Number	:	518-837-5019
Fax Number	:	518-837-5093

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

Provider Enumeration Date	:	06/26/2008
Last Update Date	:	04/24/2012

Similar Medicare Providers

1487930004 — BETH BRUNNER, DMD, PLLC
Practice Location Address:

1936 SARANAC AVE , SUITE 101
LAKE PLACID, NY
12946-1114

Practice Phone: 518-837-5019
Practice Fax: 518-837-5093

1659902468 — KIT MORGAN LCSW
Practice Location Address:

1936 SARANAC AVE
LAKE PLACID, NY
12946-1114

Practice Phone: 518-956-4214
Practice Fax:

1568025294 — MRS. KATHERINE RUTH STANKA M.S. CCC-SLP
Practice Location Address:

2711 PLACID AVE
PARKVILLE, MD
21234-1114

Practice Phone: 410-218-6229
Practice Fax:

1922078559 — DR. THOMAS M SODEMAN MD
Practice Location Address:

10 NEVADA DR
LAKE SUCCESS, NY
11042-1114

Practice Phone: 516-719-1060
Practice Fax: 516-719-1062

1306876644 — DOUGLAS H. KAHN, DPM, PA
Practice Location Address:

1114 EAST DUVAL STREET
LAKE CITY, FL
32055

Practice Phone: 386-752-7813
Practice Fax:

1073622312 — RITE AID OF OHIO INC
Practice Location Address:

4106 EAST LAKE ROAD
SHEFFIELD LAKE, OH
44054-1114

Practice Phone: 440-949-6239
Practice Fax:

Directions to “ DR. BETH BRUNNER DMD, MD, PLLC” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.