Provider Demographics
NPI:1801097514
Name:CRISPIN, BRUCE JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:JAMES
Last Name:CRISPIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:18981 VENTURA BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3237
Mailing Address - Country:US
Mailing Address - Phone:818-758-3557
Mailing Address - Fax:818-758-3559
Practice Address - Street 1:18981 VENTURA BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3237
Practice Address - Country:US
Practice Address - Phone:818-758-3557
Practice Address - Fax:818-758-3559
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA274181223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics