Provider Demographics
NPI:1629376009
Name:ETKIN, BRUCE JAY (DDS, CAGS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:JAY
Last Name:ETKIN
Suffix:
Gender:M
Credentials:DDS, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7181 E CAMELBACK RD
Mailing Address - Street 2:APT 1201
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-1279
Mailing Address - Country:US
Mailing Address - Phone:480-223-8990
Mailing Address - Fax:480-991-2474
Practice Address - Street 1:7181 E CAMELBACK RD
Practice Address - Street 2:APT 1201
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-1279
Practice Address - Country:US
Practice Address - Phone:480-223-8990
Practice Address - Fax:480-991-2474
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21881223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics