Provider Demographics
NPI:1124173174
Name:BRUCE, BERNARD CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:CHARLES
Last Name:BRUCE
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 1:4210 MCKNIGHT RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-0922
Mailing Address - Country:US
Mailing Address - Phone:903-838-0511
Mailing Address - Fax:903-832-5023
Practice Address - Street 1:4210 MCKNIGHT RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-0922
Practice Address - Country:US
Practice Address - Phone:903-838-0511
Practice Address - Fax:903-832-5023
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78451223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics