Provider Demographics
NPI:1235192782
Name:ZUCKER, BRUCE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:A
Last Name:ZUCKER
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 1:101 DORSET AVE
Mailing Address - Street 2:
Mailing Address - City:CROYDON
Mailing Address - State:PA
Mailing Address - Zip Code:19021-6224
Mailing Address - Country:US
Mailing Address - Phone:215-788-7966
Mailing Address - Fax:215-788-5997
Practice Address - Street 1:101 DORSET AVE
Practice Address - Street 2:
Practice Address - City:CROYDON
Practice Address - State:PA
Practice Address - Zip Code:19021-6224
Practice Address - Country:US
Practice Address - Phone:215-788-7966
Practice Address - Fax:215-788-5997
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0165761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice