Provider Demographics
NPI:1063751022
Name:BRUNETTE, SHERI R
Entity type:Individual
Prefix:
First Name:SHERI
Middle Name:R
Last Name:BRUNETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 OSTERMANN DR
Mailing Address - Street 2:
Mailing Address - City:TURTLE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54889-9191
Mailing Address - Country:US
Mailing Address - Phone:715-986-2020
Mailing Address - Fax:
Practice Address - Street 1:225 OSTERMANN DR
Practice Address - Street 2:
Practice Address - City:TURTLE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54889-9191
Practice Address - Country:US
Practice Address - Phone:715-986-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10674016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist