Provider Demographics
NPI:1154535961
Name:BRUNSON, ANDREW P (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:P
Last Name:BRUNSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 S 5TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-4254
Mailing Address - Country:US
Mailing Address - Phone:256-543-9572
Mailing Address - Fax:
Practice Address - Street 1:311 S 5TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-4254
Practice Address - Country:US
Practice Address - Phone:256-543-9572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL52951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice