Provider Demographics
NPI:1508668732
Name:BRUNA DE GOUVEIA LLC
Entity type:Organization
Organization Name:BRUNA DE GOUVEIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUNA
Authorized Official - Middle Name:DE
Authorized Official - Last Name:GOUVEIA
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:575-887-7594
Mailing Address - Street 1:612 N CANYON ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-5842
Mailing Address - Country:US
Mailing Address - Phone:575-887-7594
Mailing Address - Fax:
Practice Address - Street 1:612 N CANYON ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-5842
Practice Address - Country:US
Practice Address - Phone:575-887-7594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty