Provider Demographics
NPI:1649387085
Name:BRUCCI, ANTHONY A (DMD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:A
Last Name:BRUCCI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7891 BROADWAY
Mailing Address - Street 2:STE C
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410
Mailing Address - Country:US
Mailing Address - Phone:219-736-2273
Mailing Address - Fax:219-769-5233
Practice Address - Street 1:7891 BROADWAY
Practice Address - Street 2:STE C
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410
Practice Address - Country:US
Practice Address - Phone:219-736-2273
Practice Address - Fax:219-769-5233
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010244B122300000X
IN12010244A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice