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General NPI Number Information
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NPI Number | 1417219056
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Entity Type | Individual
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Provider Name | EHLIE BRUNO DDS
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Gender | Female
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Dates
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Enumeration Date | 06/11/2012
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Last Update Date | 01/18/2024
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Provider Practice Location Address
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Address Line | 5342 S ARCHER AVE
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City | CHICAGO
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State | IL
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Zip | 60632-4949
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Country | US
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Telephone | 773-284-1645
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Fax |
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Provider Business Mailing Address
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Address Line | 4849 N MILWAUKEE AVE STE 406
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City | CHICAGO
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State | IL
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Zip | 60630-2389
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Country | US
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Telephone | 414-510-6119
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Fax |
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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 | 021002890
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License Number State | IL
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