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NPI Code Detail

MEDICARE: DR. MATTHEW J BRUZEK DDS

MEDICARE:  DR. MATTHEW J BRUZEK  DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry2901020605MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12901020605OTHERMISTATE LICENSE NUMBER

General Provider Information

NPI Number : 1659414357
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATTHEW J BRUZEK DDS
Provider Business Mailing Address
First Line : 201 N RIVERSIDE AVE UNIT C3C4
Second Line :
City : SAINT CLAIR
State : MI
Zip : 48079-5491
Country : US
Telephone Number : 810-328-5225
Fax Number :
Provider Business Practice Location Address
First Line : 201 N RIVERSIDE AVE UNIT C3C4
Second Line :
City : SAINT CLAIR
State : MI
Zip : 48079-5491
Country : US
Telephone Number : 810-328-5225
Fax Number : 810-740-7020
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2007
Last Update Date : 02/15/2021

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Directions to “ DR. MATTHEW J BRUZEK DDS” Practice Location

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