Healthcare Provider Details

I. General information

NPI: 1073692430
Provider Name (Legal Business Name): JULIA MARIA BRUNO D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2006
Last Update Date: 12/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 JESSE HILL JR. DRIVE
ATLANTA GA
30303-3030
US

IV. Provider business mailing address

99 JESSE HILL JR. DRIVE
ATLANTA GA
30303-3030
US

V. Phone/Fax

Practice location:
  • Phone: 404-730-1471
  • Fax: 404-730-1475
Mailing address:
  • Phone: 404-730-1471
  • Fax: 404-730-1475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2236
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDPH00005
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: