Provider Demographics
NPI:1548412943
Name:THURSTON, BRUCE C (DDS)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:C
Last Name:THURSTON
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:PO BOX 1327
Mailing Address - Street 2:
Mailing Address - City:MABANK
Mailing Address - State:TX
Mailing Address - Zip Code:75147-1327
Mailing Address - Country:US
Mailing Address - Phone:903-887-1381
Mailing Address - Fax:903-887-6957
Practice Address - Street 1:2527 W. MAIN ST.
Practice Address - Street 2:
Practice Address - City:GUN BARREL
Practice Address - State:TX
Practice Address - Zip Code:75156
Practice Address - Country:US
Practice Address - Phone:903-887-1381
Practice Address - Fax:903-887-6957
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice