Provider Demographics
NPI:1659501336
Name:PARHAM, BRUCE DOUGLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:DOUGLAS
Last Name:PARHAM
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 1:29 THE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-2814
Mailing Address - Country:US
Mailing Address - Phone:914-235-4485
Mailing Address - Fax:718-579-8352
Practice Address - Street 1:29 THE BLVD
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-2814
Practice Address - Country:US
Practice Address - Phone:914-235-4485
Practice Address - Fax:718-579-8352
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040314122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist