Provider Demographics
NPI:1922344902
Name:BLUEBONNET DENTAL CARE NATCHEZ
Entity Type:Organization
Organization Name:BLUEBONNET DENTAL CARE NATCHEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:601-446-9099
Mailing Address - Street 1:4451 BLUEBONNET BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809
Mailing Address - Country:US
Mailing Address - Phone:225-291-5252
Mailing Address - Fax:225-223-6250
Practice Address - Street 1:101 HIGHWAY 61 SOUTH
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120
Practice Address - Country:US
Practice Address - Phone:601-446-9099
Practice Address - Fax:601-446-8207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty