Provider Demographics
NPI:1477718104
Name:THOMAS B. BRUFF, DDS PA
Entity Type:Organization
Organization Name:THOMAS B. BRUFF, DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-762-3393
Mailing Address - Street 1:1307 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7502
Mailing Address - Country:US
Mailing Address - Phone:910-762-3393
Mailing Address - Fax:910-762-9610
Practice Address - Street 1:1307 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7502
Practice Address - Country:US
Practice Address - Phone:910-762-3393
Practice Address - Fax:910-762-9610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5268261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC91156OtherBCBS
NC000124735OtherUNITED CONCORDIA
NC7991156Medicaid