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General NPI Number Information
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NPI Number | 1114210481
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Entity Type | Organization
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Legal Business Name | ABCOM FAMILY DENTAL CARE
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Dates
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Enumeration Date | 05/19/2011
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Last Update Date | 05/19/2011
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Provider Practice Location Address
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Address Line | 5402 MINERAL POINT RD
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City | MADISON
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State | WI
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Zip | 53705-4659
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Country | US
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Telephone | 608-231-2863
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Fax | 608-231-2974
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Provider Business Mailing Address
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Address Line | 5402 MINERAL POINT RD
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City | MADISON
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State | WI
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Zip | 53705-4659
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Country | US
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Telephone | 608-231-2863
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Fax | 608-231-2974
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | ROBERT C BRUCKNER
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Credential | DDS
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Telephone | 608-231-2863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 5001006015
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License Number State | WI
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