Provider Demographics
NPI:1235973199
Name:BRUNER, CHASE DANIEL (DDS)
Entity type:Individual
Prefix:DR
First Name:CHASE
Middle Name:DANIEL
Last Name:BRUNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 1ST AVE NW
Mailing Address - Street 2:
Mailing Address - City:WAUKON
Mailing Address - State:IA
Mailing Address - Zip Code:52172
Mailing Address - Country:US
Mailing Address - Phone:563-568-4528
Mailing Address - Fax:
Practice Address - Street 1:18 1ST AVE NW
Practice Address - Street 2:
Practice Address - City:WAUKON
Practice Address - State:IA
Practice Address - Zip Code:52172
Practice Address - Country:US
Practice Address - Phone:563-568-4528
Practice Address - Fax:563-568-6144
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS10223122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist