Provider Demographics
NPI:1689059974
Name:G.A. & J.A. BRUNGO & ASSOC. LTD
Entity Type:Organization
Organization Name:G.A. & J.A. BRUNGO & ASSOC. LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BRUNGO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-931-4243
Mailing Address - Street 1:440 PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15229-1843
Mailing Address - Country:US
Mailing Address - Phone:412-931-4243
Mailing Address - Fax:
Practice Address - Street 1:440 PERRY HWY
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15229-1843
Practice Address - Country:US
Practice Address - Phone:412-931-4243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS036974122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013392430OtherDENTIST
PA1942398474OtherDENTIST