Provider Demographics
NPI:1043586928
Name:BRONSON, MITCHELL S (DDS)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:S
Last Name:BRONSON
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 1:8605 CAMINO MEDIA STE 100
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-1359
Mailing Address - Country:US
Mailing Address - Phone:661-664-1814
Mailing Address - Fax:661-664-0129
Practice Address - Street 1:8605 CAMINO MEDIA STE 100
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-1359
Practice Address - Country:US
Practice Address - Phone:661-664-1814
Practice Address - Fax:661-664-0129
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA265941223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics