Provider Demographics
NPI:1306000435
Name:PETT, BRUCE RAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:RAY
Last Name:PETT
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:PO BOX 35
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:WI
Mailing Address - Zip Code:53523
Mailing Address - Country:US
Mailing Address - Phone:608-423-3012
Mailing Address - Fax:608-423-9685
Practice Address - Street 1:113 SPRING ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:WI
Practice Address - Zip Code:53523
Practice Address - Country:US
Practice Address - Phone:608-423-3012
Practice Address - Fax:608-423-9685
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1277G1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice