MEDICARE: DR. LISA DELUCIA BRUNO 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
1	1223P0221X	Pediatric Dentistry	10032	MA
2	1223P0221X	Pediatric Dentistry	055071	NY

General Provider Information

NPI Number	:	1740442672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA DELUCIA BRUNO DDS

Provider Business Mailing Address
First Line	:	1110 CROSSPOINTE LN STE D
Second Line	:
City	:	WEBSTER
State	:	NY
Zip	:	14580-2968
Country	:	US
Telephone Number	:	585-872-0150
Fax Number	:	585-872-6183

Provider Business Practice Location Address
First Line	:	1110 CROSSPOINTE LN STE D
Second Line	:
City	:	WEBSTER
State	:	NY
Zip	:	14580-2968
Country	:	US
Telephone Number	:	585-872-0150
Fax Number	:	585-872-6183

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2008
Last Update Date	:	07/06/2024

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