Provider Demographics
NPI:1770807471
Name:BRUNGO, MAURA BEIRNE (DMD)
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:BEIRNE
Last Name:BRUNGO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 OAKWOOD AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-2636
Mailing Address - Country:US
Mailing Address - Phone:814-237-4300
Mailing Address - Fax:814-272-0256
Practice Address - Street 1:100 OAKWOOD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-2636
Practice Address - Country:US
Practice Address - Phone:814-237-4000
Practice Address - Fax:814-272-0256
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028551L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist