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General NPI Number Information
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NPI Number | 1922344902
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Entity Type | Organization
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Legal Business Name | BLUEBONNET DENTAL CARE NATCHEZ
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Dates
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Enumeration Date | 12/20/2012
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Last Update Date | 12/20/2012
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Provider Practice Location Address
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Address Line | 101 HIGHWAY 61 SOUTH
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City | NATCHEZ
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State | MS
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Zip | 39120
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Country | US
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Telephone | 601-446-9099
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Fax | 601-446-8207
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Provider Business Mailing Address
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Address Line | 4451 BLUEBONNET BLVD STE F
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City | BATON ROUGE
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State | LA
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Zip | 70809
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Country | US
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Telephone | 225-291-5252
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Fax | 225-223-6250
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Authorized Official
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Title or Position | OWNER
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Name | ANDRE BRUNI
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Credential | DDS
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Telephone | 601-446-9099
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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 |
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License Number State |
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