Provider Demographics
NPI:1437257615
Name:BRUCE, JOHN MACMILLAN IV (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MACMILLAN
Last Name:BRUCE
Suffix:IV
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:M
Other - Last Name:BRUCE
Other - Suffix:IV
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2519 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-3013
Mailing Address - Country:US
Mailing Address - Phone:406-452-2964
Mailing Address - Fax:406-452-6449
Practice Address - Street 1:2519 6TH AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-3013
Practice Address - Country:US
Practice Address - Phone:406-452-2964
Practice Address - Fax:406-452-6449
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2430122300000X
IDD-37131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice