Provider Demographics
NPI:1356515241
Name:NICOLAS LEONARDI BRONZINI, D.D.S., INC.
Entity type:Organization
Organization Name:NICOLAS LEONARDI BRONZINI, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRONZINI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-697-0981
Mailing Address - Street 1:101 TAYLOR BLVD
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-1915
Mailing Address - Country:US
Mailing Address - Phone:650-697-0981
Mailing Address - Fax:650-697-0987
Practice Address - Street 1:101 TAYLOR BLVD
Practice Address - Street 2:
Practice Address - City:MILLBRAE
Practice Address - State:CA
Practice Address - Zip Code:94030-1915
Practice Address - Country:US
Practice Address - Phone:650-697-0981
Practice Address - Fax:650-697-0987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53767261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental