Provider Demographics
NPI:1508068479
Name:HARWOOD, BRUCE CHRISTOPHER (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:CHRISTOPHER
Last Name:HARWOOD
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 1:5813 W MAPLE RD
Mailing Address - Street 2:SUITE 145
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4400
Mailing Address - Country:US
Mailing Address - Phone:248-851-2240
Mailing Address - Fax:
Practice Address - Street 1:5813 W MAPLE RD
Practice Address - Street 2:SUITE 145
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4400
Practice Address - Country:US
Practice Address - Phone:248-851-2240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI15516122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI15516OtherLICENSE