Provider Demographics
NPI:1821257486
Name:BRUZZI, VICTOR LUCIANO (DDS)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:LUCIANO
Last Name:BRUZZI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:130 FORT WASHINGTON AVE
Mailing Address - Street 2:#1-B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-4724
Mailing Address - Country:US
Mailing Address - Phone:212-928-9000
Mailing Address - Fax:212-928-6569
Practice Address - Street 1:130 FORT WASHINGTON AVE
Practice Address - Street 2:#1-B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-4724
Practice Address - Country:US
Practice Address - Phone:212-928-9000
Practice Address - Fax:212-928-6569
Is Sole Proprietor?:No
Enumeration Date:2008-06-08
Last Update Date:2008-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040582-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice