Provider Demographics
NPI:1780868430
Name:BRUDER, GEORGE ANTHONY III (DMD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ANTHONY
Last Name:BRUDER
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:STONY BROOK DENTAL ASSOCIATES INC
Mailing Address - Street 2:SULLIVAN HALL - ROOM 170 - FACULTY PRACTICE
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8705
Mailing Address - Country:US
Mailing Address - Phone:631-632-8971
Mailing Address - Fax:631-632-7658
Practice Address - Street 1:STONY BROOK DENTAL ASSOCIATES INC
Practice Address - Street 2:SULLIVAN HALL - ROOM 170 - FACULTY PRACTICE
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8705
Practice Address - Country:US
Practice Address - Phone:631-632-8971
Practice Address - Fax:631-632-7658
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50 0509281223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics