Brian Timothy Brunacini, DDS
Individual provider Active NPI Dentist · Rockport, ME
NPI 1083845663 · NPPES record last updated Jul 30, 2009
Key facts
- NPI
- 1083845663
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DEN4113 (ME)
- Practice address
- 625 Rockland St
Rockport, ME 04856-5320 - Phone
- (207) 236-3100
- NPI assigned
- Jul 30, 2009
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DEN4113 | ME | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Randal Joseph Thivierge | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DEN4113 | ME | Yes |
Addresses
Primary practice location
625 Rockland St
Rockport, ME 04856-5320
Mailing address
625 Rockland St
Rockport, ME 04856-5320
Phone (207) 236-3100
Other providers in Rockport, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 30, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.