Provider Demographics
NPI:1255083846
Name:LISA DELUCIA BRUNO DDS PLLC
Entity type:Organization
Organization Name:LISA DELUCIA BRUNO DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:DELUCIA
Authorized Official - Last Name:BRUNO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-506-7085
Mailing Address - Street 1:39 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-2933
Mailing Address - Country:US
Mailing Address - Phone:585-872-0150
Mailing Address - Fax:
Practice Address - Street 1:39 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2933
Practice Address - Country:US
Practice Address - Phone:585-872-0150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty