Provider Demographics
NPI:1861547424
Name:PATRICK, BRUCE (DDS)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:PATRICK
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 1:5919 117TH PL SW
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-4879
Mailing Address - Country:US
Mailing Address - Phone:425-349-3283
Mailing Address - Fax:
Practice Address - Street 1:22010 17TH AVE SE
Practice Address - Street 2:#B
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-8486
Practice Address - Country:US
Practice Address - Phone:425-481-8571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice