Organization
BRUNK FAMILY DENTAL CARE
Active
Parent organization
FAMILY DENTAL CARE
Organization subpart
Yes
Provider details
NPI number
Legal business name
FAMILY DENTAL CARE
Authorized official
DR. MARK G BRUNK D.M.D. (DENTIST)
(618) 283-2929
Entity
Organization
Contact information
Practice address
805 MARKET ST, UNIT B, METROPOLIS, IL 62960-1635
(618) 940-0542
Mailing address
607 W ORCHARD ST, VANDALIA, IL 62471-1234
(618) 940-0542
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019019107
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
096681291
—
IL
05
—
1001332
—
IL
Enumeration date
02/25/2013
Last updated
02/25/2013
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