Healthcare Provider Details

I. General information

NPI: 1134132459
Provider Name (Legal Business Name): BRUNS FAMILY DENTAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6860 BLUEBONNET BLVD STE B
BATON ROUGE LA
70810-1615
US

IV. Provider business mailing address

6860 BLUEBONNET BLVD STE B
BATON ROUGE LA
70810-1615
US

V. Phone/Fax

Practice location:
  • Phone: 225-769-0222
  • Fax: 225-769-0212
Mailing address:
  • Phone: 225-769-0222
  • Fax: 225-769-0212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number5173
License Number StateLA

VIII. Authorized Official

Name: DR. ROBERT E BRUNS IV
Title or Position: OWNER DENTIST
Credential: DDS
Phone: 225-769-0222