Provider Demographics
NPI:1194847731
Name:SCIULLI, BRUNO ANTONIO (DMD)
Entity type:Individual
Prefix:DR
First Name:BRUNO
Middle Name:ANTONIO
Last Name:SCIULLI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 ATWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-4026
Mailing Address - Country:US
Mailing Address - Phone:412-682-0804
Mailing Address - Fax:412-682-0922
Practice Address - Street 1:360 ATWOOD ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-4026
Practice Address - Country:US
Practice Address - Phone:412-682-0804
Practice Address - Fax:412-682-0922
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029092L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA202677OtherCIGNA PROVIDER #
PA859321OtherCONCORDIA ID#