Provider Demographics
NPI:1952576209
Name:WREGE, BRUCE R (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:R
Last Name:WREGE
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 1:7373 E 21ST ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-1718
Mailing Address - Country:US
Mailing Address - Phone:317-357-7373
Mailing Address - Fax:317-353-2330
Practice Address - Street 1:7373 E 21ST ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-1718
Practice Address - Country:US
Practice Address - Phone:317-357-7373
Practice Address - Fax:317-353-2330
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007402A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice