Healthcare Provider Details

I. General information

NPI: 1275869455
Provider Name (Legal Business Name): GERARD J BRUNO DDS MS ORAL AND FACIAL SURGERY LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2009
Last Update Date: 10/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4573 EVERHARD RD NW
CANTON OH
44718-2406
US

IV. Provider business mailing address

4573 EVERHARD RD NW
CANTON OH
44718-2406
US

V. Phone/Fax

Practice location:
  • Phone: 330-499-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number21583
License Number StateOH

VIII. Authorized Official

Name: DR. GERARD BRUNO
Title or Position: OWNER
Credential:
Phone: 330-499-2000