Individual
JEFFREY HOWELL BRUNNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2730 S MOODY AVE, PORTLAND, OR 97201-5042
(503) 346-4708
Mailing address
2730 S MOODY AVE, PORTLAND, OR 97201-5042
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D7406
OR
1223G0001X
General Practice Dentistry
D7406
OR
Other
Enumeration date
03/05/2024
Last updated
03/05/2024
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