Provider Demographics
NPI:1104806934
Name:JUNNILA, BRENDA M (DDS)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:M
Last Name:JUNNILA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:206 N HILL AVE
Mailing Address - City:OGILVIE
Mailing Address - State:MN
Mailing Address - Zip Code:56358-0069
Mailing Address - Country:US
Mailing Address - Phone:320-272-4450
Mailing Address - Fax:320-272-4860
Practice Address - Street 1:206 N HILL AVE
Practice Address - Street 2:
Practice Address - City:OGILVIE
Practice Address - State:MN
Practice Address - Zip Code:56358-4501
Practice Address - Country:US
Practice Address - Phone:320-272-4450
Practice Address - Fax:320-272-4860
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN87761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice