Basic Information
| Provider Information | |||||||||
| NPI: | 1013994292 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRUNER | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | KAWABORI | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS, MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 JARRETT WHITE ROAD | ||||||||
| Address2: | ATTN: MCDS-NH US ARMY DENTAL ACTIVITY HAWAII | ||||||||
| City: | TRIPLER AMC | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968595000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084331021 | ||||||||
| FaxNumber: | 8084333928 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 JARRETT WHITE ROAD | ||||||||
| Address2: | ATTN: MCDS-NH US ARMY DENTAL ACTIVITY HAWAII | ||||||||
| City: | TRIPLER AMC | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968595000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084331021 | ||||||||
| FaxNumber: | 8084333928 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | 2013 | HI | Y | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.