1588709075 NPI number — FRANK D. BRUNI,D.D.S., PLC

Table of content: (NPI 1588709075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588709075 NPI number — FRANK D. BRUNI,D.D.S., PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRANK D. BRUNI,D.D.S., PLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588709075
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9220 FOREST HILL AVE
Provider Second Line Business Mailing Address:
SUITE A-6
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23235-6800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-272-4711
Provider Business Mailing Address Fax Number:
804-330-0077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9220 FOREST HILL AVE
Provider Second Line Business Practice Location Address:
SUITE A-6
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23235-6800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-272-4711
Provider Business Practice Location Address Fax Number:
804-330-0077
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BRUNI
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
DOUGLASS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
804-272-4711

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  0401005955 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 115139 . This is a "ANTHEM GROUP NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5955 . This is a "DELTA DENTAL PROVIDER NUM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 821425 . This is a "UNITED CONCORDIA NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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