Provider Demographics
NPI:1205971769
Name:ULRICH, BRUCE MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MICHAEL
Last Name:ULRICH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:ANN
Other - Last Name:WOODS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1112 LINCOLN WAY
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-5121
Mailing Address - Country:US
Mailing Address - Phone:530-885-8331
Mailing Address - Fax:530-885-6036
Practice Address - Street 1:1112 LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-5121
Practice Address - Country:US
Practice Address - Phone:530-885-8331
Practice Address - Fax:530-885-6036
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA244131223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics