Provider Demographics
NPI:1003871781
Name:MAHAFFEY, BRUCE M (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:M
Last Name:MAHAFFEY
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 1:8805 SW 144TH ST
Mailing Address - Street 2:
Mailing Address - City:VILLAGE OF PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7218
Mailing Address - Country:US
Mailing Address - Phone:305-253-6944
Mailing Address - Fax:605-251-9989
Practice Address - Street 1:8805 SW 144TH ST
Practice Address - Street 2:
Practice Address - City:VILLAGE OF PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33176-7218
Practice Address - Country:US
Practice Address - Phone:305-253-6944
Practice Address - Fax:605-251-9989
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL58081223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70054Medicaid