Individual
DR. KENNETH L BRUNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS.,MS.,
Contact information
Practice address
212 E COURT ST, DYERSBURG, TN 38024-4742
(731) 285-9657
(731) 285-0055
Mailing address
212 E COURT ST, DYERSBURG, TN 38024-4742
(731) 285-9657
(731) 285-0055
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DS1826
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0018158
DENTAL PROVIDER
TN
Enumeration date
11/07/2006
Last updated
07/08/2007
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