Provider Demographics
NPI:1245387521
Name:BRUNGO FAMILY DENTISTRY
Entity Type:Organization
Organization Name:BRUNGO FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRUNGO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:814-237-4300
Mailing Address - Street 1:234 E COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-4757
Mailing Address - Country:US
Mailing Address - Phone:814-237-4300
Mailing Address - Fax:814-237-4303
Practice Address - Street 1:234 E COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-4757
Practice Address - Country:US
Practice Address - Phone:814-237-4300
Practice Address - Fax:814-237-4303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028734L1223G0001X
PADS028551L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty