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General NPI Number Information
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NPI Number | 1356515241
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Entity Type | Organization
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Legal Business Name | NICOLAS LEONARDI BRONZINI, D.D.S., INC.
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 101 TAYLOR BLVD
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City | MILLBRAE
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State | CA
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Zip | 94030-1915
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Country | US
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Telephone | 650-697-0981
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Fax | 650-697-0987
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Provider Business Mailing Address
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Address Line | 101 TAYLOR BLVD
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City | MILLBRAE
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State | CA
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Zip | 94030-1915
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Country | US
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Telephone | 650-697-0981
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Fax | 650-697-0987
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | NICOLAS L BRONZINI
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Credential | D.D.S.
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Telephone | 650-697-0981
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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 | 53767
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License Number State | CA
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