Provider Demographics
NPI:1841313533
Name:SMALL, BRUCE W (DMD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:W
Last Name:SMALL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 FRANKLIN CORNER RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2531
Mailing Address - Country:US
Mailing Address - Phone:609-896-0529
Mailing Address - Fax:609-895-1236
Practice Address - Street 1:133 FRANKLIN CORNER RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2531
Practice Address - Country:US
Practice Address - Phone:609-896-0529
Practice Address - Fax:609-895-1236
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ9646122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist