| Organization Name: | BETH BRUNNER, DMD, PLLC |
| NPI Number: | 1487930004 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BETH BRUNNER (OWNER) |
| Mailing Address: | 1936 Saranac Ave Suite 101 Lake Placid |
| State: | NY US |
| Postal Code: | 129461114 |
| Phone Number: | 5188375019 |
| Fax Number: | 5188375093 |
| NPI Enumeration Date: | 10/27/2011 |
| NPI Last Update Date: | 04/26/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 054553 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |