Provider Demographics
NPI:1902203532
Name:BRUCE, CARLTON JAMES (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARLTON
Middle Name:JAMES
Last Name:BRUCE
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 1:1 NASSAU ST
Mailing Address - Street 2:UNIT 1509
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1542
Mailing Address - Country:US
Mailing Address - Phone:404-275-1137
Mailing Address - Fax:
Practice Address - Street 1:298 LINCOLN ST SW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-5469
Practice Address - Country:US
Practice Address - Phone:704-792-2313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-25
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856779122300000X
NC11712122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist