Provider Demographics
NPI:1013454461
Name:BRUCE N. LEIN DDS, PA
Entity Type:Organization
Organization Name:BRUCE N. LEIN DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS - OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:N
Authorized Official - Last Name:LEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-744-6121
Mailing Address - Street 1:825 S US HIGHWAY 1
Mailing Address - Street 2:SUITE 250
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-5976
Mailing Address - Country:US
Mailing Address - Phone:561-744-6121
Mailing Address - Fax:561-401-9367
Practice Address - Street 1:825 S US HIGHWAY 1
Practice Address - Street 2:SUITE 250
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-5976
Practice Address - Country:US
Practice Address - Phone:561-744-6121
Practice Address - Fax:561-401-9367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 17633122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty