1033251517 NPI number — DR. JOSEPH DOMENIC BRUZZESE DDS

Table of content: DR. JOSEPH DOMENIC BRUZZESE DDS (NPI 1033251517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033251517 NPI number — DR. JOSEPH DOMENIC BRUZZESE DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRUZZESE
Provider First Name:
JOSEPH
Provider Middle Name:
DOMENIC
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

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:
1033251517
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2452 RAM CROSSING WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-896-6220
Provider Business Mailing Address Fax Number:
702-734-7473

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2430 E HARMON AVE
Provider Second Line Business Practice Location Address:
STE 4
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-734-6202
Provider Business Practice Location Address Fax Number:
702-734-7473
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  579 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 731270 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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