Provider Demographics
NPI:1306885538
Name:DUCHAN, BRUCE ROBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ROBERT
Last Name:DUCHAN
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 1:911 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-3215
Mailing Address - Country:US
Mailing Address - Phone:248-336-8478
Mailing Address - Fax:
Practice Address - Street 1:911 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-3215
Practice Address - Country:US
Practice Address - Phone:248-336-8478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010133471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI880421OtherUNITED CONCORDIA
MID133470OtherBLUE CROSS BLUE SHIELD