| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 6411 34th St, Berwyn, Illinois |
| Authorized Official Name and Position | Anthony A Brucci (OWNER) |
| Authorized Official Contact | 7084846576 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
6411 34th St Berwyn IL 60402-3717 Ph: (708) 484-6576 | 6411 34th St Berwyn IL 60402-3717 Ph: (708) 484-6576 |
| NPI Number | 1124358551 |
|---|---|
| Provider Enumeration Date | 01/07/2010 |
| Last Update Date | 01/07/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124358551 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 019023728 (Illinois) | Primary |
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