Provider Demographics
NPI:1861645913
Name:BRUCKNER, JOSEPH AARON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:AARON
Last Name:BRUCKNER
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 1:14119 70TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1927
Mailing Address - Country:US
Mailing Address - Phone:347-236-0043
Mailing Address - Fax:
Practice Address - Street 1:14119 70TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1927
Practice Address - Country:US
Practice Address - Phone:347-236-0043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-02
Last Update Date:2008-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053088122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist