Provider Demographics
NPI:1235206624
Name:BRUGOS, MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:BRUGOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3351 EL CAMINO REAL
Mailing Address - Street 2:SUITE 235
Mailing Address - City:ATHERTON
Mailing Address - State:CA
Mailing Address - Zip Code:94027-3811
Mailing Address - Country:US
Mailing Address - Phone:650-365-1533
Mailing Address - Fax:650-365-1511
Practice Address - Street 1:3351 EL CAMINO REAL
Practice Address - Street 2:SUITE 235
Practice Address - City:ATHERTON
Practice Address - State:CA
Practice Address - Zip Code:94027-3811
Practice Address - Country:US
Practice Address - Phone:650-365-1533
Practice Address - Fax:650-365-1511
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21973122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist