Bruzek, Mark John
Bruzek, Mark John is an individual health care provider with primary practice located at 4419 Air Base Road , Hermantown MN 55811. He recently has only one registered license in Dental Providers / Pediatric Dentistry, which is considered as his primary health care specialty. Bruzek, Mark John can be contacted via phone (218) 728-2117.Contact Information
Primary practice address
4419 Air Base Road
Hermantown MN 55811
Phone: (218) 728-2117
Fax: (218) 728-2700
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Pediatric Dentistry | 1223P0221X | 3444 | Wisconsin |
| Dental Providers / Pediatric Dentistry | 1223P0221X | S27 | Minnesota |
Profile Details
| NPI number | 1568687044 |
|---|---|
| LBN Legal business name | Bruzek, Mark John |
| Credentials | D.D.S., M.S. |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 17th, 2007 |
| Last updated | Jul 30th, 2013 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1568687044 | NPPES |
| Wisconsin | MEDICAID | 33473800 | |
| Wisconsin | Other | 3444 |
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