Provider Demographics
NPI:1376718213
Name:BRUCE H. COLLIGNON D.D.S., P.C.
Entity Type:Organization
Organization Name:BRUCE H. COLLIGNON D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:H
Authorized Official - Last Name:COLLIGNON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:636-671-0102
Mailing Address - Street 1:7214 EXECUTIVE PKWY
Mailing Address - Street 2:
Mailing Address - City:HOUSE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:63051-2981
Mailing Address - Country:US
Mailing Address - Phone:636-671-0102
Mailing Address - Fax:636-671-1575
Practice Address - Street 1:7214 EXECUTIVE PKWY
Practice Address - Street 2:
Practice Address - City:HOUSE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:63051-2981
Practice Address - Country:US
Practice Address - Phone:636-671-0102
Practice Address - Fax:636-671-1575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0122561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty