Provider Demographics
NPI:1740225556
Name:WILAND, BRUCE B (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:B
Last Name:WILAND
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5162 E STOP 11 RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8617
Mailing Address - Country:US
Mailing Address - Phone:317-888-3322
Mailing Address - Fax:317-888-8325
Practice Address - Street 1:5162 E STOP 11 RD
Practice Address - Street 2:SUITE 2
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8617
Practice Address - Country:US
Practice Address - Phone:317-888-3322
Practice Address - Fax:317-888-8325
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120089451223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU62144Medicare UPIN
IN367200Medicare ID - Type Unspecified