Provider Demographics
NPI:1639381890
Name:BRUNI, ANDRE H (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:H
Last Name:BRUNI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11001 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-4306
Mailing Address - Country:US
Mailing Address - Phone:225-277-3311
Mailing Address - Fax:225-351-8859
Practice Address - Street 1:7017 PERKINS RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4320
Practice Address - Country:US
Practice Address - Phone:225-277-3311
Practice Address - Fax:225-351-8859
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA53151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
852927446OtherGENERAL DENTIST
LA85-2927446OtherGENERAL DENTIST