# BLUEBONNET DENTAL CARE @ MANDEVILLE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720492291
- **Authorized official:** ANDRE BRUNI DDS (CEO)
- **Authorized official phone:** (504) 908-8877

## Contact information

- **Practice address:** 4040 LONESOME RD, MANDEVILLE, LA 70448-7085
- **Practice address phone:** (225) 778-7832
- **Mailing address:** 4451 BLUEBONNET BLVD STE F, BATON ROUGE, LA 70809-9647
- **Mailing address phone:** (225) 778-7832

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 6494 | LA | Yes |

## Other

- **Enumeration date:** 06/12/2014
- **Last updated:** 06/16/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1223 | DENTIST | LA |