Provider Demographics
NPI:1528147600
Name:AHTYE, BRUCE A (DDS)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:A
Last Name:AHTYE
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 1:20099 REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-4326
Mailing Address - Country:US
Mailing Address - Phone:510-881-1611
Mailing Address - Fax:510-881-0254
Practice Address - Street 1:20099 REDWOOD RD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4326
Practice Address - Country:US
Practice Address - Phone:510-881-1611
Practice Address - Fax:510-881-0254
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice