Provider Demographics
NPI:1144546052
Name:GONCALVES, REGINALDO BRUNO (DDS)
Entity type:Individual
Prefix:DR
First Name:REGINALDO
Middle Name:BRUNO
Last Name:GONCALVES
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 1:2420 RUE DE LA TERRASSE
Mailing Address - Street 2:
Mailing Address - City:QUEBEC
Mailing Address - State:QUEBEC
Mailing Address - Zip Code:G1V0A6
Mailing Address - Country:CA
Mailing Address - Phone:418-575-2182
Mailing Address - Fax:
Practice Address - Street 1:2420 RUE DE LA TERRASSE
Practice Address - Street 2:
Practice Address - City:QUEBEC
Practice Address - State:QUEBEC
Practice Address - Zip Code:G1V0A6
Practice Address - Country:CA
Practice Address - Phone:418-575-2182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program