Provider Demographics
NPI:1457561961
Name:CARSTENSEN, BRUCE J (DMD, PC)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:J
Last Name:CARSTENSEN
Suffix:
Gender:M
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6751 SE THIESSEN RD STE A
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-1800
Mailing Address - Country:US
Mailing Address - Phone:503-786-7792
Mailing Address - Fax:503-794-8372
Practice Address - Street 1:6751 SE THIESSEN RD STE A
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-1800
Practice Address - Country:US
Practice Address - Phone:503-786-7792
Practice Address - Fax:503-794-8372
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD6405122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist