Provider Demographics
NPI:1548502198
Name:CLINICA Y LABORATORIO DENTAL BRUNO & ASSOC.
Entity type:Organization
Organization Name:CLINICA Y LABORATORIO DENTAL BRUNO & ASSOC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:EVELISSE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-438-8257
Mailing Address - Street 1:CALLE C URB GUARICO
Mailing Address - Street 2:H-8
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-438-8257
Mailing Address - Fax:
Practice Address - Street 1:CALLE MARGINAL MONTECARLO #124
Practice Address - Street 2:SUITE 3
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-438-8257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental