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General NPI Number Information
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NPI Number | 1013050913
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Entity Type | Individual
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Provider Name | GERARD J BRUNO DDS
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Gender | Male
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 07/28/2009
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Provider Practice Location Address
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Address Line | 4573 EVERHARD RD NW
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City | CANTON
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State | OH
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Zip | 44718-2406
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Country | US
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Telephone | 330-499-2000
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Fax | 330-499-2000
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Provider Business Mailing Address
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Address Line | 4573 EVERHARD RD NW
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City | CANTON
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State | OH
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Zip | 44718-2406
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Country | US
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Telephone | 330-499-2000
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Fax | 330-499-2000
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 21583
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License Number State | OH
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