Individual
JORDAN TYLER BRUNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
4898 LITTLE RD, ARLINGTON, TX 76017-1054
(614) 668-0880
Mailing address
5307 E MOCKINGBIRD LN STE 325, DALLAS, TX 75206-5109
(214) 821-5011
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
36152
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/11/2020
Last updated
06/29/2020
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