Provider Demographics
NPI:1568683142
Name:HAVENS, BRUCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:HAVENS
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 1:7429 N 1ST ST
Mailing Address - Street 2:STE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2852
Mailing Address - Country:US
Mailing Address - Phone:559-448-9870
Mailing Address - Fax:559-448-9870
Practice Address - Street 1:7429 N 1ST ST
Practice Address - Street 2:STE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2852
Practice Address - Country:US
Practice Address - Phone:559-448-9870
Practice Address - Fax:559-448-9870
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA461881223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics