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NPI Code Detail

MEDICARE: BRONSON DENTAL PRACTICE, INC.

MEDICARE: BRONSON DENTAL PRACTICE, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QD0000XDental Clinic/Center31754CA

General Provider Information

NPI Number : 1225233935
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRONSON DENTAL PRACTICE, INC.
Provider Business Mailing Address
First Line : 550 WATER ST STE K4
Second Line :
City : SANTA CRUZ
State : CA
Zip : 95060-4136
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 550 WATER ST STE K4
Second Line :
City : SANTA CRUZ
State : CA
Zip : 95060-4136
Country : US
Telephone Number : 831-212-3997
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : JAMES MERRITT BRONSON
Credential : D.D.S.
Telephone Number : 831-212-3997
Provider Enumeration Date : 06/21/2007
Last Update Date : 08/22/2020

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Directions to “BRONSON DENTAL PRACTICE, INC. ” Practice Location

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