Individual
DR. MARK JOHN BRUZEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.
Contact information
Practice address
4419 AIR BASE ROAD, HERMANTOWN, MN 55811
(218) 728-2117
(218) 728-2700
Mailing address
4419 AIR BASE ROAD, HERMANTOWN, MN 55811
(218) 728-2117
(218) 728-2700
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
3444
WI
1223P0221X
Pediatric Dentistry
Primary
S27
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33473800
—
WI
01
—
3444
DELTA DENTAL WI ID#
WI
Enumeration date
04/17/2007
Last updated
07/30/2013
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