Provider Demographics
NPI:1346372794
Name:BRUCE, BRETT STANLEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:STANLEY
Last Name:BRUCE
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 1:6995 GADSDEN HWY
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173
Mailing Address - Country:US
Mailing Address - Phone:205-655-8525
Mailing Address - Fax:205-655-7494
Practice Address - Street 1:6995 GADSDEN HWY
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173
Practice Address - Country:US
Practice Address - Phone:205-655-8525
Practice Address - Fax:205-655-7494
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL48271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice