Provider Demographics
NPI:1164529541
Name:BRUCE, STEVEN M (DMD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:BRUCE
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 1:7878 USTICK ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5848
Mailing Address - Country:US
Mailing Address - Phone:208-376-2920
Mailing Address - Fax:208-376-8509
Practice Address - Street 1:7878 USTICK ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5848
Practice Address - Country:US
Practice Address - Phone:208-376-2920
Practice Address - Fax:208-376-8509
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD16261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice