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General NPI Number Information
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NPI Number | 1508701830
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Entity Type | Organization
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Legal Business Name | DANIEL B BRUIN DMD LLC
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Dates
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Enumeration Date | 04/22/2026
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Last Update Date | 04/22/2026
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Provider Practice Location Address
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Address Line | 1811 MARTIN SPRINGS DR STE A
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City | ROLLA
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State | MO
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Zip | 65401-2978
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Country | US
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Telephone | 941-468-5193
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Fax |
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Provider Business Mailing Address
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Address Line | 1811 MARTIN SPRINGS DR STE A
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City | ROLLA
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State | MO
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Zip | 65401-2978
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Country | US
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Telephone | 941-468-5193
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DANIEL BRADLEY BRUIN
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Credential | BRUIN
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Telephone | 941-468-5193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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