Provider Demographics
NPI:1811349517
Name:NEIVA, BRUNA (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:BRUNA
Middle Name:
Last Name:NEIVA
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3223 N BROAD ST
Mailing Address - Street 2:ROOM 311 - 3RD FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-5007
Mailing Address - Country:US
Mailing Address - Phone:215-707-2953
Mailing Address - Fax:
Practice Address - Street 1:3223 N BROAD ST RM 319
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5007
Practice Address - Country:US
Practice Address - Phone:215-707-2953
Practice Address - Fax:215-707-2802
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-06
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1617122300000X
PARFD0000571223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1811349517OtherUNIVERSITY OF FLORIDA