Provider Demographics
NPI:1619901857
Name:PODHOUSER, BRUCE JOY (DMD ABO)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:JOY
Last Name:PODHOUSER
Suffix:
Gender:M
Credentials:DMD ABO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 ROSEWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:ME
Mailing Address - Zip Code:04071
Mailing Address - Country:US
Mailing Address - Phone:207-627-9927
Mailing Address - Fax:
Practice Address - Street 1:440 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106
Practice Address - Country:US
Practice Address - Phone:207-772-5487
Practice Address - Fax:207-772-7553
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3405122300000X
NH3772122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist