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NPI Code Detail

MEDICARE: BLUEBONNET DENTAL CARE

MEDICARE: BLUEBONNET DENTAL CARE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry5315LA

General Provider Information

NPI Number : 1235343781
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLUEBONNET DENTAL CARE
Provider Business Mailing Address
First Line : 4451 BLUEBONNET BLVD
Second Line : STE A
City : BATON ROUGE
State : LA
Zip : 70809-9639
Country : US
Telephone Number : 225-767-2273
Fax Number : 225-769-3395
Provider Business Practice Location Address
First Line : 4451 BLUEBONNET BLVD
Second Line : STE A
City : BATON ROUGE
State : LA
Zip : 70809-9639
Country : US
Telephone Number : 225-767-2273
Fax Number : 225-769-3395
Authorized Official
Title or Position : OWNER
Name : ANDRE BRUNI
Credential :
Telephone Number : 225-767-2273
Provider Enumeration Date : 05/10/2007
Last Update Date : 08/22/2020

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Directions to “BLUEBONNET DENTAL CARE ” Practice Location

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