Provider Demographics
NPI:1285853960
Name:WHITCHER, BRUCE L (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:L
Last Name:WHITCHER
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 1:990 BOYSEN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1313
Mailing Address - Country:US
Mailing Address - Phone:805-541-3220
Mailing Address - Fax:805-541-3220
Practice Address - Street 1:990 BOYSEN AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1313
Practice Address - Country:US
Practice Address - Phone:805-541-3220
Practice Address - Fax:805-541-3220
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADX0301281223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU-17930Medicare UPIN