Provider Demographics
NPI:1740442672
Name:BRUNO, LISA DELUCIA (DDS)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:DELUCIA
Last Name:BRUNO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:DELUCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1110 CROSSPOINTE LN STE D
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-2968
Mailing Address - Country:US
Mailing Address - Phone:585-872-0150
Mailing Address - Fax:585-872-6183
Practice Address - Street 1:1110 CROSSPOINTE LN STE D
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2968
Practice Address - Country:US
Practice Address - Phone:585-872-0150
Practice Address - Fax:585-872-6183
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA100321223P0221X
NY0550711223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry