Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 2901016363 | MI |
NPI | 1326166604 |
---|---|
Provider Name | Dr. Anthony Giacomo Brusca |
First Address | Globe, AS 85501 |
Second Address | Globe, AZ 85501-1328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8045 | (05) | AK |