Provider Demographics
NPI:1326127861
Name:SMITH, BRUCE C (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 E GRAND AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3435
Mailing Address - Country:US
Mailing Address - Phone:760-741-1355
Mailing Address - Fax:
Practice Address - Street 1:850 E GRAND AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3435
Practice Address - Country:US
Practice Address - Phone:760-741-1355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA265331223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics