Provider Demographics
NPI:1487665477
Name:KAUFMAN, BRUCE WAYNE (DDS)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:WAYNE
Last Name:KAUFMAN
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 1:1864 SOUTH KENTWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2323
Mailing Address - Country:US
Mailing Address - Phone:417-883-1597
Mailing Address - Fax:417-883-1519
Practice Address - Street 1:1864 SOUTH KENTWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2323
Practice Address - Country:US
Practice Address - Phone:417-883-1597
Practice Address - Fax:417-883-1519
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO13324122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist