Provider Demographics
NPI:1992839435
Name:HARSHA, BRUCE BUCHANAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:BUCHANAN
Last Name:HARSHA
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 1:5212 E CAMINO BOSQUE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-4618
Mailing Address - Country:US
Mailing Address - Phone:520-577-4509
Mailing Address - Fax:
Practice Address - Street 1:6744 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2807
Practice Address - Country:US
Practice Address - Phone:520-298-9771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO92501223G0001X
AZD008349122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice