Provider Demographics
NPI:1689888604
Name:SLOAN, BRUCE WALTER (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:WALTER
Last Name:SLOAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 OUTWATER LANE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-2254
Mailing Address - Country:US
Mailing Address - Phone:973-478-3960
Mailing Address - Fax:
Practice Address - Street 1:308 OUTWATER LANE
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026-2254
Practice Address - Country:US
Practice Address - Phone:973-478-3960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI095431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice