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General NPI Number Information
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NPI Number | 1306900675
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Entity Type | Individual
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Provider Name | RONALD A BRUNGO D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 234 E COLLEGE AVE
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City | STATE COLLEGE
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State | PA
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Zip | 16801-4757
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Country | US
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Telephone | 814-237-4300
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Fax | 814-237-4303
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Provider Business Mailing Address
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Address Line | 234 E COLLEGE AVE
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City | STATE COLLEGE
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State | PA
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Zip | 16801-4757
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Country | US
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Telephone | 814-237-4300
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Fax | 814-237-4303
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS028734L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS028551L
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License Number State | PA
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