Provider Demographics
NPI:1124116611
Name:DENTLER, BRUCE HOWARD (MD, ABFP, CMD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:HOWARD
Last Name:DENTLER
Suffix:
Gender:M
Credentials:MD, ABFP, CMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 W. ROSEWOOD AVE.
Mailing Address - Street 2:GERIATRIC FAMILY CARE
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-4257
Mailing Address - Country:US
Mailing Address - Phone:509-465-9776
Mailing Address - Fax:509-465-9058
Practice Address - Street 1:1010 W ROSEWOOD AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-4257
Practice Address - Country:US
Practice Address - Phone:509-465-9776
Practice Address - Fax:509-465-9058
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00014194207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1073923Medicaid
WAA07158Medicare UPIN