Provider Demographics
NPI:1285610022
Name:DUMKE, BRUCE G (DDS)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:G
Last Name:DUMKE
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 1:430 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-0700
Mailing Address - Country:US
Mailing Address - Phone:507-345-4259
Mailing Address - Fax:507-345-4460
Practice Address - Street 1:430 S BROAD ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-0700
Practice Address - Country:US
Practice Address - Phone:507-345-4259
Practice Address - Fax:507-345-4460
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice