Healthcare Provider Details

I. General information

NPI: 1649387085
Provider Name (Legal Business Name): ANTHONY A BRUCCI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7891 BROADWAY STE C
MERRILLVILLE IN
46410
US

IV. Provider business mailing address

7891 BROADWAY STE C
MERRILLVILLE IN
46410
US

V. Phone/Fax

Practice location:
  • Phone: 219-736-2273
  • Fax: 219-769-5233
Mailing address:
  • Phone: 219-736-2273
  • Fax: 219-769-5233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number12010244B
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12010244A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: