Provider Demographics
NPI:1306157631
Name:BRUNER, ANDREW (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:BRUNER
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 MARKET ST STE 1000
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5549
Mailing Address - Country:US
Mailing Address - Phone:215-573-8400
Mailing Address - Fax:215-573-5550
Practice Address - Street 1:3737 MARKET ST STE 1000
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5549
Practice Address - Country:US
Practice Address - Phone:215-573-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PADS0385741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program