Provider Demographics
NPI:1275109266
Name:BRUNO, CHRISTINE NATALIE (DDS)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:NATALIE
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 1:1600 E GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-1128
Mailing Address - Country:US
Mailing Address - Phone:262-720-6707
Mailing Address - Fax:
Practice Address - Street 1:W213N16755 GLEN BROOKE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WI
Practice Address - Zip Code:53037-9489
Practice Address - Country:US
Practice Address - Phone:262-677-4990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10026481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice