NPIMap

Organization Active NPI

Bluebonnet Dental Care @ Mandeville LLC

  • Dentist
  • Mandeville, LA
National Provider Identifier
1720492291
Registry record updated Jun 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
6494 Issued in LA
Legal business name
BLUEBONNET DENTAL CARE @ MANDEVILLE LLC
Practice address
4040 Lonesome Rd
Mandeville, LA 70448-7085
Phone
(225) 778-7832
NPI assigned
Jun 12, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2014

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

Authorized official

Name
Andre Bruni, DDS
Title
Ceo
Phone
(504) 908-8877

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 6494 LA Primary

Addresses

Primary practice location

4040 Lonesome Rd
Mandeville, LA 70448-7085

Mailing address

4451 Bluebonnet Blvd Ste F
Baton Rouge, LA 70809-9647
Phone (225) 778-7832

Other identifiers 1

IdentifierTypeStateIssuer
1223OtherLADENTIST

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1402531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402876800000",
    "number": "1720492291",
    "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": "708099647",
            "telephone_number": "225-778-7832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4040 LONESOME RD",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704487085",
            "telephone_number": "225-778-7832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEBONNET DENTAL CARE @ MANDEVILLE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-12",
        "last_updated": "2014-06-16",
        "status": "A",
        "authorized_official_last_name": "BRUNI",
        "authorized_official_first_name": "ANDRE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "504-908-8877",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "LA",
            "license": "6494",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTIST",
            "identifier": "1223",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mandeville, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2014; 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.