Brunk Family Dental Care
Organization Active NPI Dentist · Metropolis, IL
NPI 1497095608 · NPPES record last updated Feb 25, 2013
Key facts
- NPI
- 1497095608
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dentist 122300000X
- License
- 019019107 (IL)
- Legal business name
- BRUNK FAMILY DENTAL CARE
- Practice address
- 805 Market St
Unit B
Metropolis, IL 62960-1635 - Phone
- (618) 940-0542
- NPI assigned
- Feb 25, 2013
- Organization subpart
- Yes
- Parent organization (as reported)
- FAMILY DENTAL CARE
Authorized official
- Name
- Dr. Mark G Brunk, D.M.D.
- Title
- Dentist
- Phone
- (618) 283-2929
National Provider Directory
- Part of
- Brunk Family Dental Care
Locations
805 Market St
Unit B
Metropolis, IL 62960
Phone (618) 940-0542
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist |
122300000X | 019019107 | IL | Yes |
Addresses
Primary practice location
805 Market St
Unit B
Metropolis, IL 62960-1635
Mailing address
607 W Orchard St
Vandalia, IL 62471-1234
Phone (618) 940-0542
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 096681291 | Medicaid | IL | |
| 1001332 | Medicaid | IL |
Other providers in Metropolis, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 25, 2013. 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.