Provider Demographics
NPI:1104932037
Name:DOLL, BRUCE (DDS)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:DOLL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10325 RDIGECREST POINT
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9600
Mailing Address - Country:US
Mailing Address - Phone:724-934-8403
Mailing Address - Fax:724-934-8403
Practice Address - Street 1:10325 RIDGECREST PT
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9600
Practice Address - Country:US
Practice Address - Phone:724-934-8403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025154L1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics