Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DS-027407L | PA |
NPI | 1144349705 |
---|---|
Provider Name | Frank Bruno |
First Address | Jenkintown, PA 19046-2938 |
Second Address | Media, PA 19063-5121 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 08/07/2007 |