Jennifer Ann Brunacini, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DEN4114 Issued in ME

Practice address

284 Cumberland Ave.
Portland High School, Amanda Rowe Health Clinic
Portland, ME 04101

Phone

(207) 842-4653

Fax

(207) 828-8802

NPI assigned

Jul 9, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jennifer Ann Fultz Former name

Medicare fee-for-service enrollment

Enrolled in ME

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1247097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420502400000",
    "number": "1467681601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "389 CONGRESS ST.",
            "address_2": "THE CITY OF PORTLAND, PUBLIC HEALTH DIVISION",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "04101",
            "telephone_number": "207-874-8944",
            "fax_number": "207-874-8913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "284 CUMBERLAND AVE.",
            "address_2": "PORTLAND HIGH SCHOOL, AMANDA ROWE HEALTH CLINIC",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "04101",
            "telephone_number": "207-842-4653",
            "fax_number": "207-828-8802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUNACINI",
        "first_name": "JENNIFER",
        "middle_name": "ANN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-09",
        "last_updated": "2015-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ME",
            "license": "DEN4114",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "434739499",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "FULTZ",
            "middle_name": "ANN",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Rebecca Sargent Brown, LCSW
• Susan B. Brown, NP
• Laura E Browne
• Anthony C. Brucato, LCPC-C
• Allen Thomas Bruce, MD PHD
• Kelly Bruneau, LCPC
• Randi-Anne Bruneau, LCSW, CADC, CCS
• Christine Brunette, RN
• Nicole Bruso, LMT
• Felicia Nicole Bryant, RD, LDN

• Dentist in Portland, ME
• Providers in Portland, ME by specialty
• Dentist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.