Organization
BLUEBONNET DENTAL CARE @ MANDEVILLE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDRE BRUNI DDS (CEO)
(504) 908-8877
Entity
Organization
Contact information
Practice address
4040 LONESOME RD, MANDEVILLE, LA 70448-7085
(225) 778-7832
Mailing address
4451 BLUEBONNET BLVD STE F, BATON ROUGE, LA 70809-9647
(225) 778-7832
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6494
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1223
DENTIST
LA
Enumeration date
06/12/2014
Last updated
06/16/2014
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