Provider Demographics
NPI:1134204365
Name:BRUCE, GREGORY SCOTT (DDS)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:SCOTT
Last Name:BRUCE
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 1:1372 N SUSQUEHANNA TRAIL
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870
Mailing Address - Country:US
Mailing Address - Phone:570-743-2062
Mailing Address - Fax:570-743-8196
Practice Address - Street 1:1372 N SUSQUEHANNA TRAIL
Practice Address - Street 2:SUITE 320
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870
Practice Address - Country:US
Practice Address - Phone:570-743-2062
Practice Address - Fax:570-743-8196
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027622L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist