Provider Demographics
NPI:1437271178
Name:BRUNO, MICHELE L (DDS)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:L
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 1:541 SULLIVAN RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-1406
Mailing Address - Country:US
Mailing Address - Phone:630-897-1156
Mailing Address - Fax:630-896-5374
Practice Address - Street 1:541 SULLIVAN RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1406
Practice Address - Country:US
Practice Address - Phone:630-897-1156
Practice Address - Fax:630-896-5374
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice