Provider Demographics
NPI:1508514647
Name:JOHN J. BRUNGO, DMD
Entity Type:Organization
Organization Name:JOHN J. BRUNGO, DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHURIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-335-1232
Mailing Address - Street 1:4137 LEECHBURG RD
Mailing Address - Street 2:
Mailing Address - City:NEW KENSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15068-2305
Mailing Address - Country:US
Mailing Address - Phone:724-335-1232
Mailing Address - Fax:724-335-1237
Practice Address - Street 1:4137 LEECHBURG RD
Practice Address - Street 2:
Practice Address - City:NEW KENSINGTON
Practice Address - State:PA
Practice Address - Zip Code:15068-2305
Practice Address - Country:US
Practice Address - Phone:724-335-1232
Practice Address - Fax:724-335-1237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental