Provider Demographics
NPI:1659567519
Name:JOHN S. BUGNI DMD, PC
Entity Type:Organization
Organization Name:JOHN S. BUGNI DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BUGNI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-758-1505
Mailing Address - Street 1:2444 NW PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3991
Mailing Address - Country:US
Mailing Address - Phone:541-758-1505
Mailing Address - Fax:541-758-6411
Practice Address - Street 1:2444 NW PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3991
Practice Address - Country:US
Practice Address - Phone:541-758-1505
Practice Address - Fax:541-758-6411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD51501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty