Bluebonnet Dental Care Hattiesburg LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

BLUEBONNET DENTAL CARE HATTIESBURG LLC

Practice address

6668 Hwy 98 West Ste G
Hattiesburg, MS 39402

Phone

(225) 767-2273

NPI assigned

Jun 19, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Andre Bruni, DDS

Title

Owner

Phone

(225) 767-2273

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1371600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373846400000",
    "number": "1154760510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4451 BLUEBONNET BLVD STE F",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "70809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6668 HWY 98 WEST STE G",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "39402",
            "telephone_number": "225-767-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEBONNET DENTAL CARE HATTIESBURG LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-19",
        "last_updated": "2013-07-15",
        "status": "A",
        "authorized_official_last_name": "BRUNI",
        "authorized_official_first_name": "ANDRE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "225-767-2273",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hayden Elise Blakeman
• Susan E Blakeney, FNP
• Monica V Blakley, FNP-C
• Bertha J Blanchard, MD
• Kevin P Blanchard, MD
• Lynn Boardman, MS,CCC-SLP
• Ketankumar Bodarya, MD
• Ernest Bodie, PCCSS
• Christine Boehmer, LPC
• Torkeshia Bolar

• General Practice Dentistry in Hattiesburg, MS
• Providers in Hattiesburg, MS by specialty
• General Practice Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.