Provider Demographics
NPI:1609027903
Name:BRUCE DOW, D.D.S., P.C.
Entity Type:Organization
Organization Name:BRUCE DOW, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:775-945-2438
Mailing Address - Street 1:155 SOUTH C STREET
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NV
Mailing Address - Zip Code:89415-2507
Mailing Address - Country:US
Mailing Address - Phone:775-945-2438
Mailing Address - Fax:775-945-1348
Practice Address - Street 1:155 SOUTH C STREET
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NV
Practice Address - Zip Code:89415-2507
Practice Address - Country:US
Practice Address - Phone:775-945-2438
Practice Address - Fax:775-945-1348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2137261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2211600Medicaid