Provider Demographics
NPI:1114940921
Name:HIURA, BRUCE TAKASHI (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:TAKASHI
Last Name:HIURA
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 1:2305 VAN NESS AVE STE E
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-1899
Mailing Address - Country:US
Mailing Address - Phone:415-776-5855
Mailing Address - Fax:415-776-4656
Practice Address - Street 1:2305 VAN NESS AVE STE E
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-1899
Practice Address - Country:US
Practice Address - Phone:415-776-5855
Practice Address - Fax:415-776-4656
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30826122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist