Provider Demographics
NPI:1851493852
Name:CHA, BRUCE Y (DMD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:Y
Last Name:CHA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 WASHINGTON AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3271
Mailing Address - Country:US
Mailing Address - Phone:203-281-6574
Mailing Address - Fax:203-281-1045
Practice Address - Street 1:60 WASHINGTON AVE
Practice Address - Street 2:STE 202
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3271
Practice Address - Country:US
Practice Address - Phone:203-281-6574
Practice Address - Fax:203-281-1045
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT67691223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics