MEDICARE: DR. STEVEN C BRUDERER D.M.D.

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
1	1223G0001X	General Practice Dentistry	6662737-9921	UT
2	1223G0001X	General Practice Dentistry	6662737-9922	UT

General Provider Information

NPI Number	:	1841448008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN C BRUDERER D.M.D.

Provider Business Mailing Address
First Line	:	1887 AARON DR STE A
Second Line	:
City	:	TOOELE
State	:	UT
Zip	:	84074-8138
Country	:	US
Telephone Number	:	435-833-9900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1887 AARON DR STE A
Second Line	:
City	:	TOOELE
State	:	UT
Zip	:	84074-8138
Country	:	US
Telephone Number	:	435-833-9900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2008
Last Update Date	:	11/01/2010

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Directions to “ DR. STEVEN C BRUDERER D.M.D.” Practice Location

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