Provider Demographics
NPI:1841326105
Name:BRUCE A MATER DDS LLC
Entity type:Organization
Organization Name:BRUCE A MATER DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MATER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-288-9300
Mailing Address - Street 1:2948 HWY 62
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-7293
Mailing Address - Country:US
Mailing Address - Phone:812-288-9300
Mailing Address - Fax:812-288-9602
Practice Address - Street 1:2948 HWY 62
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-7293
Practice Address - Country:US
Practice Address - Phone:812-288-9300
Practice Address - Fax:812-288-9602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN7886122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty