Provider Demographics
NPI:1720169659
Name:BRUNO, RICHARD A (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:BRUNO
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 N CROOKS RD
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-1399
Mailing Address - Country:US
Mailing Address - Phone:248-435-2000
Mailing Address - Fax:248-435-8945
Practice Address - Street 1:730 N CROOKS RD
Practice Address - Street 2:
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-1399
Practice Address - Country:US
Practice Address - Phone:248-435-2000
Practice Address - Fax:248-435-8945
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010167231223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics