Provider Demographics
NPI:1275614273
Name:BAVITZ, JOSEPH BRUCE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:BRUCE
Last Name:BAVITZ
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 1:40TH HOLDREGE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68583-0757
Mailing Address - Country:US
Mailing Address - Phone:402-472-8900
Mailing Address - Fax:402-472-6681
Practice Address - Street 1:40TH HOLDREGE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68583-0757
Practice Address - Country:US
Practice Address - Phone:402-472-8900
Practice Address - Fax:402-472-6681
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE55881223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47078998500Medicaid
NE5840OtherBC/BS
NE269460Medicare PIN
NE5840OtherBC/BS