Individual
CANDACE LAUREN BRUNO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
11410 JOLLYVILLE RD, 3102, AUSTIN, TX 78759-4097
(512) 372-8484
Mailing address
7416 TURNBUOY DR, AUSTIN, TX 78730-4333
(619) 261-4073
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0025624
TX
1223G0001X
General Practice Dentistry
0025624
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2128852-01
—
TX
Enumeration date
07/12/2010
Last updated
02/13/2017
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