Mark A Brunner, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

12499 Issued in GA

Practice address

2064 Baldwin St Ste a
Jenison, MI 49428-8773

Phone

(616) 264-3815

Fax

(404) 352-9381

NPI assigned

Jul 18, 2006

Last updated

Mar 14, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Previously, effective Aug 1, 2018 through Aug 1, 2026

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741910400000",
    "number": "1891714135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2064 BALDWIN ST STE A",
            "city": "JENISON",
            "state": "MI",
            "postal_code": "494288773",
            "telephone_number": "404-352-3123",
            "fax_number": "404-352-9381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2064 BALDWIN ST STE A",
            "city": "JENISON",
            "state": "MI",
            "postal_code": "494288773",
            "telephone_number": "616-264-3815",
            "fax_number": "404-352-9381"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "518 Lincolnway W",
            "address_purpose": "LOCATION",
            "city": "Mishawaka",
            "state": "IN",
            "postal_code": "465441807",
            "country_code": "US",
            "telephone_number": "574-255-5630",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRUNNER",
        "first_name": "MARK",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2025-03-14",
        "certification_date": "2025-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "GA",
            "license": "12499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brooke Nicole Brouwer, LMSW
• Andrea Brown
• Karlyn Brown, M.S., CCC-SLP
• Bruce a Seitz DDS PC
• Hope Lynn Brucki-Markoski, OTR/L
• Molly Buist, OTL
• Deanne Burke
• Kendra Burmeister, MA CCC-SLP
• Erik Byl, MS, AT, ATC
• Carol Byrne, AU.D.

• Periodontics in Jenison, MI
• Providers in Jenison, MI by specialty
• Periodontics in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2025; 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.