Provider Demographics
NPI:1154563765
Name:PRIOR, BRUCE THOMAS (DMD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:THOMAS
Last Name:PRIOR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:216 STEEPLECHASE DRIVE
Mailing Address - Street 2:BRUCE T. PRIOR D.M.D.
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-4233
Mailing Address - Country:US
Mailing Address - Phone:215-393-3525
Mailing Address - Fax:215-393-9242
Practice Address - Street 1:216 STEEPLECHASE DRIVE
Practice Address - Street 2:BRUCE T. PRIOR, D.M.D.
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-4233
Practice Address - Country:US
Practice Address - Phone:215-393-3525
Practice Address - Fax:215-393-9242
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020375L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist