Provider Demographics
NPI:1962534636
Name:T.E.BRUNO, INC.
Entity type:Organization
Organization Name:T.E.BRUNO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:BRUNO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:404-992-8760
Mailing Address - Street 1:5937 HIGHWAY 42
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-3800
Mailing Address - Country:US
Mailing Address - Phone:770-961-6272
Mailing Address - Fax:770-961-0472
Practice Address - Street 1:5937 HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-3800
Practice Address - Country:US
Practice Address - Phone:770-961-6272
Practice Address - Fax:770-961-0472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0101191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty