Beth Brunner, DMD, MD, PLLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

054553 Issued in NY

Practice address

1936 Saranac Ave
Suite 101
Lake Placid, NY 12946-1114

Phone

(518) 837-5019

Fax

(518) 837-5093

NPI assigned

Jun 26, 2008

Last updated

Apr 24, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 6, 2016 through Jan 6, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Beth Brunner, DMD, PLLC

  dba Lake Placid Oral Surgery

  • Dental Clinic/Center
  • Lake Placid, NY
  • NPI 1487930004
  NPD (past) Authorized official

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

{
    "created_epoch": "1214438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335225600000",
    "number": "1649432139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1936 SARANAC AVE",
            "address_2": "SUITE 101",
            "city": "LAKE PLACID",
            "state": "NY",
            "postal_code": "129461114",
            "telephone_number": "518-837-5019",
            "fax_number": "518-837-5093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1936 SARANAC AVE",
            "address_2": "SUITE 101",
            "city": "LAKE PLACID",
            "state": "NY",
            "postal_code": "129461114",
            "telephone_number": "518-837-5019",
            "fax_number": "518-837-5093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUNNER",
        "first_name": "BETH",
        "name_prefix": "Dr.",
        "credential": "DMD, MD, PLLC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-06-26",
        "last_updated": "2012-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "054553",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexander Baldwin
• David J Balestrini, D.M.D.
• Elizabeth Bartos, M.D.
• Beth Brunner, DMD, PLLC (Lake Placid Oral Surgery)
• Molly Breen, OTR/L
• Daniel P Bullock, MD
• Eugene Byrne, MD
• Capital District Optimal Health Inc (High Peaks Optimal Health)
• John Joseph Cerruti, DC
• Denis Chagnon, M.D.

• Oral and Maxillofacial Surgery (Dentist) in Lake Placid, NY
• Providers in Lake Placid, NY by specialty
• Oral and Maxillofacial Surgery (Dentist) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2012; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.