MEDICARE: DR. LAWRENCE G BRUN DDS

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	1223G0001X	General Practice Dentistry	30 016043	OH

General Provider Information

NPI Number	:	1992839989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE G BRUN DDS

Provider Business Mailing Address
First Line	:	2650 WOODMAN CENTER CT
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45420-1477
Country	:	US
Telephone Number	:	937-294-6703
Fax Number	:	937-294-0780

Provider Business Practice Location Address
First Line	:	2650 WOODMAN CENTER CT
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45420-1477
Country	:	US
Telephone Number	:	937-294-6703
Fax Number	:	937-294-0780

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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