Provider Demographics
NPI:1033226246
Name:ALLEN, BRUCE WELLS (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:WELLS
Last Name:ALLEN
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 1:205 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-9027
Mailing Address - Country:US
Mailing Address - Phone:989-773-7195
Mailing Address - Fax:
Practice Address - Street 1:205 CEDAR DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-9027
Practice Address - Country:US
Practice Address - Phone:989-773-7195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI093921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice