Provider Demographics
NPI:1811027410
Name:CAIN, BRUCE EDWARD (DDS)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:EDWARD
Last Name:CAIN
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 1:410 W 18 RD
Mailing Address - Street 2:
Mailing Address - City:MESICK
Mailing Address - State:MI
Mailing Address - Zip Code:49668
Mailing Address - Country:US
Mailing Address - Phone:231-885-3271
Mailing Address - Fax:231-885-2493
Practice Address - Street 1:5055 N M 37
Practice Address - Street 2:
Practice Address - City:MESICK
Practice Address - State:MI
Practice Address - Zip Code:49668
Practice Address - Country:US
Practice Address - Phone:231-885-1711
Practice Address - Fax:231-885-2493
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901016563122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4473849Medicaid