Doctor Name: | DR. MARK JOHN BRUZEK |
NPI Number: | 1568687044 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.D.S., M.S. |
License Number: | 3444 |
Business Practice Address: | 4419 Air Base Road Hermantown, MN - 55811 |
Business Phone Number: | 2187282117 |
Business Fax Number: | 2187282700 |
Mailing Address: | 4419 Air Base Road, HERMANTOWN |
State: | MN |
Postal Code: | 55811 |
Phone Number: | 2187282117 |
Fax Number: | 2187282700 |
NPI Enumeration Date: | 04/17/2007 |
NPI Last Update Date: | 07/30/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1223P0221X |
License Number: | 3444 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WI |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Dentist |
Taxonomy Specialization: | Pediatric Dentistry |
Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |