Provider Demographics
NPI:1922164359
Name:BEGOTKA, BRUCE ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALLEN
Last Name:BEGOTKA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:431 E CLAIREMONT AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-3685
Mailing Address - Country:US
Mailing Address - Phone:715-830-5010
Mailing Address - Fax:715-830-5020
Practice Address - Street 1:431 E CLAIREMONT AVE
Practice Address - Street 2:SUITE C
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-3685
Practice Address - Country:US
Practice Address - Phone:715-830-5010
Practice Address - Fax:715-830-5020
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4590-0151223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics