# BETH BRUNNER, DMD, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lake Placid Oral Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487930004
- **Authorized official:** DR. BETH BRUNNER DMD, MD, PLLC (OWNER)
- **Authorized official phone:** (518) 837-5019

## Contact information

- **Practice address:** 1936 SARANAC AVE, SUITE 101, LAKE PLACID, NY 12946-1114
- **Practice address phone:** (518) 837-5019
- **Practice address fax:** (518) 837-5093
- **Mailing address:** 1936 SARANAC AVE, SUITE 101, LAKE PLACID, NY 12946-1114
- **Mailing address phone:** (518) 837-5019
- **Mailing address fax:** (518) 837-5093

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 054553 | NY | Yes |

## Other

- **Enumeration date:** 10/27/2011
- **Last updated:** 04/26/2012