Provider Demographics
NPI:1538312947
Name:HUMMEL, BRUCE K (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:K
Last Name:HUMMEL
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 1:1324 23RD ST S STE 1A
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3702
Mailing Address - Country:US
Mailing Address - Phone:701-237-5616
Mailing Address - Fax:701-271-8813
Practice Address - Street 1:1324 23RD ST S
Practice Address - Street 2:SUITE 1A
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3702
Practice Address - Country:US
Practice Address - Phone:701-237-5616
Practice Address - Fax:701-271-8813
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1392122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist