Provider Demographics
NPI:1235432360
Name:BRUNO, LUCILA (DDS)
Entity Type:Individual
Prefix:
First Name:LUCILA
Middle Name:
Last Name:BRUNO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 WILLOW ST
Mailing Address - Street 2:APT. 412
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-1939
Mailing Address - Country:US
Mailing Address - Phone:617-276-4160
Mailing Address - Fax:
Practice Address - Street 1:532 SUMNER AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01108-2458
Practice Address - Country:US
Practice Address - Phone:413-693-1045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-11
Last Update Date:2013-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18555381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice