Provider Demographics
NPI:1306011168
Name:TRIMBLE, BRUCE WAYNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:WAYNE
Last Name:TRIMBLE
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 1:620 W CLAIREMONT AVE
Mailing Address - Street 2:CHIPPEWA VALLEY TECHNICAL COLLEGE DENTAL HYGIENE PROGRA
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701
Mailing Address - Country:US
Mailing Address - Phone:715-833-6370
Mailing Address - Fax:715-833-6447
Practice Address - Street 1:620 W CLAIREMONT AVE
Practice Address - Street 2:CHIPPEWA VALLEY TECHNICAL COLLEGE DENTAL HYGIENE PROGRA
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701
Practice Address - Country:US
Practice Address - Phone:715-833-6370
Practice Address - Fax:715-833-6447
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50002310151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice