Provider Demographics
NPI:1134235112
Name:ROSENBAUM, BRUCE EUGENE (DDS)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:EUGENE
Last Name:ROSENBAUM
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 1:4045 NE LAKEWOOD WAY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-1703
Mailing Address - Country:US
Mailing Address - Phone:816-350-9119
Mailing Address - Fax:
Practice Address - Street 1:4045 NE LAKEWOOD WAY
Practice Address - Street 2:SUITE 150
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-1703
Practice Address - Country:US
Practice Address - Phone:816-350-9119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0124251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice