Organization
BRUNK FAMILY DENTAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLI JEAN NEWELL D.M.D (DENTIST)
(618) 283-2929
Entity
Organization
Contact information
Practice address
805 MARKET ST, METROPOLIS, IL 62960-1635
(618) 940-0542
Mailing address
805 MARKET ST, METROPOLIS, IL 62960-1635
(618) 940-0542
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019028666
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
096681291
—
IL
Enumeration date
06/06/2013
Last updated
06/06/2013
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