Provider Demographics
NPI:1851440952
Name:ADAMS, BRUCE WILLIAM
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:WILLIAM
Last Name:ADAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 S RANCHO SANTA FE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-3698
Mailing Address - Country:US
Mailing Address - Phone:760-471-6801
Mailing Address - Fax:760-471-9080
Practice Address - Street 1:555 S RANCHO SANTA FE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-3698
Practice Address - Country:US
Practice Address - Phone:760-471-6801
Practice Address - Fax:760-471-9080
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADG0345831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice