Provider Demographics
NPI:1346769494
Name:MATTHEW J. BRUZEK, D.D.S., P.L.L.C.
Entity Type:Organization
Organization Name:MATTHEW J. BRUZEK, D.D.S., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRUZEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-328-5225
Mailing Address - Street 1:201 N RIVERSIDE AVE UNIT C3C4
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:MI
Mailing Address - Zip Code:48079-5491
Mailing Address - Country:US
Mailing Address - Phone:810-328-5225
Mailing Address - Fax:810-740-7020
Practice Address - Street 1:201 N RIVERSIDE AVE UNIT C3C4
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR
Practice Address - State:MI
Practice Address - Zip Code:48079-5491
Practice Address - Country:US
Practice Address - Phone:810-201-6562
Practice Address - Fax:810-740-7020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental