Provider Demographics
NPI:1255738126
Name:BRUCKNER DENTAL GROUP LLP
Entity type:Organization
Organization Name:BRUCKNER DENTAL GROUP LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANDOR
Authorized Official - Middle Name:
Authorized Official - Last Name:HALPERT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-589-3131
Mailing Address - Street 1:910 THIERIOT AVE
Mailing Address - Street 2:APT 1C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-3203
Mailing Address - Country:US
Mailing Address - Phone:718-589-3131
Mailing Address - Fax:718-589-3135
Practice Address - Street 1:910 THIERIOT AVE
Practice Address - Street 2:APT 1C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-3203
Practice Address - Country:US
Practice Address - Phone:718-589-3131
Practice Address - Fax:718-589-3135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050791122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty