Provider Demographics
NPI:1720722150
Name:BRONZINI, JOSEPH WALTER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:WALTER
Last Name:BRONZINI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 117640
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94011-7640
Mailing Address - Country:US
Mailing Address - Phone:650-773-3903
Mailing Address - Fax:
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:650-697-9405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA189661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice