Provider Demographics
NPI:1083713481
Name:BRUNGO, JOHN J (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:BRUNGO
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 1:4137 LEECHBURG ROAD
Mailing Address - Street 2:STATE ROUTE 56
Mailing Address - City:NEW KENSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15068
Mailing Address - Country:US
Mailing Address - Phone:724-335-1232
Mailing Address - Fax:724-335-1237
Practice Address - Street 1:4137 LEECHBURG ROAD
Practice Address - Street 2:STATE ROUTE 56
Practice Address - City:NEW KENSINGTON
Practice Address - State:PA
Practice Address - Zip Code:15068
Practice Address - Country:US
Practice Address - Phone:724-335-1232
Practice Address - Fax:724-335-1237
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 025239L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice