Provider Demographics
NPI:1437888039
Name:WALKOWIAK, BRUNO (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRUNO
Middle Name:
Last Name:WALKOWIAK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3490 MOUNT HICKORY BLVD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-3129
Mailing Address - Country:US
Mailing Address - Phone:570-417-0330
Mailing Address - Fax:
Practice Address - Street 1:2545 W STATE ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-1036
Practice Address - Country:US
Practice Address - Phone:724-658-4840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS043659122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist