Provider Demographics
NPI:1962556654
Name:CHALL, BRUCE (DDS)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:CHALL
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 1:9 PLEASANT ST
Mailing Address - Street 2:PO BOX 1012
Mailing Address - City:MARION
Mailing Address - State:MA
Mailing Address - Zip Code:02738-1642
Mailing Address - Country:US
Mailing Address - Phone:508-748-6677
Mailing Address - Fax:508-748-6677
Practice Address - Street 1:9 PLEASANT ST
Practice Address - Street 2:SUITE 1012
Practice Address - City:MARION
Practice Address - State:MA
Practice Address - Zip Code:02738-1642
Practice Address - Country:US
Practice Address - Phone:508-748-6677
Practice Address - Fax:508-748-6677
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA117071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice