Provider Demographics
NPI:1962682260
Name:BRUNO, MATTHEW JAMES (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JAMES
Last Name:BRUNO
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:ALAN
Other - Last Name:MAYS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:1489 E THOUSAND OAKS BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-6208
Mailing Address - Country:US
Mailing Address - Phone:805-496-1861
Mailing Address - Fax:805-473-5341
Practice Address - Street 1:1489 E THOUSAND OAKS BLVD STE 3
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-6208
Practice Address - Country:US
Practice Address - Phone:805-496-1861
Practice Address - Fax:805-473-5341
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA435221223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics