Provider Demographics
NPI:1407570146
Name:DODA, BRUNILDA
Entity Type:Individual
Prefix:
First Name:BRUNILDA
Middle Name:
Last Name:DODA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 COMMONS PARK N APT 1455
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-7185
Mailing Address - Country:US
Mailing Address - Phone:914-258-2278
Mailing Address - Fax:
Practice Address - Street 1:320 BOSTON AVE
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-5213
Practice Address - Country:US
Practice Address - Phone:203-375-1388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13579122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist