Provider Demographics
NPI:1083766273
Name:JOSEPH W BRONZINI DDS
Entity Type:Organization
Organization Name:JOSEPH W BRONZINI DDS
Other - Org Name:BRONZINI DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:DELUCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-697-9405
Mailing Address - Street 1:101 TAYLOR BLVD
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94080
Mailing Address - Country:US
Mailing Address - Phone:650-697-9405
Mailing Address - Fax:650-697-4971
Practice Address - Street 1:101 TAYLOR BLVD
Practice Address - Street 2:
Practice Address - City:MILLBRAE
Practice Address - State:CA
Practice Address - Zip Code:94030
Practice Address - Country:US
Practice Address - Phone:650-697-9405
Practice Address - Fax:650-697-7849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18966122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty