Organization
KENNETH L. BRUNSON, DDS, MS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH L BRUNSON DDS, MS (DOCTOR/OWNER)
(731) 285-9657
Entity
Organization
Contact information
Practice address
1950 US HIGHWAY 51 BYP N, SUITE A, DYERSBURG, TN 38024-1896
(731) 285-9657
(731) 285-0055
Mailing address
1950 US HIGHWAY 51 BYP N, SUITE A, DYERSBURG, TN 38024-1896
(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
—
18158
DORAL DENTAL USA
TN
Enumeration date
04/07/2008
Last updated
04/07/2008
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