Provider Demographics
NPI:1932264389
Name:BRUCKER, GLORIA MERCEDES (DDS)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:MERCEDES
Last Name:BRUCKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14705 PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-1831
Mailing Address - Country:US
Mailing Address - Phone:310-644-1600
Mailing Address - Fax:310-644-1670
Practice Address - Street 1:14705 PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-1831
Practice Address - Country:US
Practice Address - Phone:310-644-1600
Practice Address - Fax:310-644-1670
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26139122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist