DR. MARK JOHN BRUZEK D.D.S. M.S. NPI 1568687044

NPI Information

NPI: 1568687044
Provider Name: DR. MARK JOHN BRUZEK, D.D.S., M.S.
Classification: Dentist - 1223P0221X
Specialization: Pediatric Dentistry
Entity Type: Individual
Address: 4419 AIR BASE ROAD
HERMANTOWN, MN
ZIP 55811
Phone: (218) 728-2117

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NPI Details

DR. Mark John Bruzek, D.D.S., M.S. is a pediatric dentistry dentist in Hermantown, MN. The provider is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. DR. Mark John Bruzek, D.D.S., M.S. NPI is 1568687044. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

4419 AIR BASE ROAD
HERMANTOWN, MN
ZIP 55811
Phone: (218) 728-2117
Fax: (218) 728-2700

The enumeration date for this NPI number is 4/17/2007 and was last updated on 7/30/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1223P0221X	Dentist	Pediatric Dentistry	3444	WISCONSIN	No
2	1223P0221X	Dentist	Pediatric Dentistry	S27	MINNESOTA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	33473800	MEDICAID	WISCONSIN
2	3444	OTHER	WISCONSIN	DELTA DENTAL WI ID#

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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