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General NPI Number Information
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NPI Number | 1346769494
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Entity Type | Organization
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Legal Business Name | MATTHEW J. BRUZEK, D.D.S., P.L.L.C.
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Dates
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Enumeration Date | 09/10/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 201 N RIVERSIDE AVE UNIT C3C4
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City | SAINT CLAIR
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State | MI
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Zip | 48079-5491
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Country | US
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Telephone | 810-201-6562
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Fax | 810-740-7020
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Provider Business Mailing Address
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Address Line | 201 N RIVERSIDE AVE UNIT C3C4
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City | SAINT CLAIR
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State | MI
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Zip | 48079-5491
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Country | US
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Telephone | 810-328-5225
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Fax | 810-740-7020
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Authorized Official
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Title or Position | OWNER
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Name | DR. MATTHEW J BRUZEK
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Credential | DDS
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Telephone | 810-328-5225
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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 |
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License Number State |
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