Provider Demographics
NPI:1487747218
Name:WHAM, BRUCE FRANKLIN (DDS)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:FRANKLIN
Last Name:WHAM
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 1:3309 HEALY DRIVE
Mailing Address - Street 2:STE D
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103
Mailing Address - Country:US
Mailing Address - Phone:336-760-5768
Mailing Address - Fax:336-760-5768
Practice Address - Street 1:3309 HEALY DRIVE
Practice Address - Street 2:STE D
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-760-5768
Practice Address - Fax:336-760-5768
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC5115122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5115OtherBLUE CROSS BLUE SHIELD